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A case of spontaneous cervical internal carotid artery dissection Junichi SHIMADA 1,2 , Hideki BANDAI 1 , Katsumi SUZUKAWA 1 , Masashi AMOU 1 1Department of Neurosurgery, Misato Junshin Hospital Keyword: internal carotid artety , dissection , MRI , dynamic CT pp.67-71
Published Date 1997/1/10
DOI https://doi.org/10.11477/mf.1436901334
  • Abstract
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Dissection of the extracranial carotid artery is a re-cognized cause of ischemia, paticularly in young persons who present with acute neurologic deficits, both tran-sient and permanent. We describe a patient with a spontaneous dissection of the cervical internal carotid artery (ICA).

A previously healthy 24-year-old man was hospital-ized because of a sudden onset of right hemiparesis' and consciousness disturbance. In reality, right cervical pain preceded this attack. The first brain MRI revealed a cerebral infarction in the right cerebral hemisphere in-cluding basal ganglia. A conventional angiography was performed 1 week later. The following angiographic picture was considered to be consistent with the dia-gnosis of cervical artery dissection: gradually tapered occlusion beginning distal to the carotid bifurcation.And MRA revealed the same finding. A cervical MRI revealed as an eccentric signal void (corresponding to the residual lumen) surrounded by a semilunar hyperin-tensity (corresponding to the mural hematoma) on T1-and T2-weighted images. Dynamic CT scan (D-CT) re-vealed an eccentric and crescent contrast enhancement (corresponding to the residual lumen) surrounded by a relative hypodensity compared with muscle (corresponding to the mural hematoma), itself sur-rounded by a thin annular enhancement. From these re-sults, we diagnosed this patient with ICA occlusion for dissection of the extracranial carotid artery. But we de-cided this case contraindication of anastomosis because he had had a major stroke.

Our findings suggest that MRA, cervical MRI and D-CT provide early recognition of internal carotid artery dissection and monitoring of its resolution. Thus, these studies may guide clinical decisions according to the development of the dissection.


Copyright © 1997, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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