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Neurological Surgery No Shinkei Geka Volume 25, Issue 1 （January 1997）

Neurological Surgery 脳神経外科 25巻1号（1997年1月発行）

Japanese English

症例

若年者の脳梗塞として発症した特発性頸部内頸動脈解離の1例:神経放射線学的所見を中心に A case of spontaneous cervical internal carotid artery dissection 嶋田淳一 ^1,2 , 萬代秀樹 ¹ , 鈴川活水 ¹ , 天羽正志 ¹ Junichi SHIMADA ^1,2 , Hideki BANDAI ¹ , Katsumi SUZUKAWA ¹ , Masashi AMOU ¹ ¹三郷順心病院脳神経外科 ²順天堂大学脳神経外科 ¹Department of Neurosurgery, Misato Junshin Hospital キーワード： internal carotid artety , dissection , MRI , dynamic CT Keyword: internal carotid artety , dissection , MRI , dynamic CT pp.67-71

発行日 1997年1月10日 Published Date 1997/1/10

DOI https://doi.org/10.11477/mf.1436901334

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Abstract 文献概要
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I．はじめに

　従来，特発性頸部内頸動脈解離は，欧米と比較して本邦においては稀とされてきた^1,6）．しかし，近年の画像診断技術の発達などに伴い，本邦においても報告例が増加してきている^5,7,9,12）．われわれは，24歳という若年者の脳梗塞として発症した特発性頸部内頸動脈解離の1例を経験したので，その神経放射線学的所見を中心に報告する．

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.