Terasaki T, Yonehara T, Fujioka S, Hashimoto Y, Uchino M
Saiseikai Kumamoto Hospital, Department of Neurology.
Rinsho Shinkeigaku. 1999 Jun;39(6):619-24.
Case 1: a 57-year-old woman, who suddenly developed disturbance of consciousness, left spatial neglect, and left hemiparesis, was admitted to our hospital on the day 1. Brain CT scan on the day 2 revealed broad edematous infarction in her middle cerebral artery territory. The dissection of the thoracic aorta was observed with transesophageal echocardiography and brain embolism due to mural thrombus of the dissecting thoracic aorta was suspected. Case 2: a 67-year-old woman, who developed disturbance of consciousness, left spatial neglect, and left hemiparesis, was admitted to our hospital on the day 15. Brain CT scan on the day 15 showed non-edematous infarction in her middle cerebral artery territory. Contrast thoracic CT scan on the day 31 revealed the dissection of the thoracic aorta. No clinical exacerbation was observed, but brain CT scan on the day 94 showed broad infarction in her middle and anterior cerebral artery territories. It is considered that pseudolumen of the dissected thoracic aorta caused occlusion of her right internal carotid artery. Transesophageal echocardiography, or contrast thoracic CT scan should be considered for detection of the dissection of the thoracic aorta in the cases of cryptogenic stroke.
病例1：一名57岁女性，突然出现意识障碍、左侧空间忽视和左侧偏瘫，于第1天入住我院。第2天的脑部CT扫描显示大脑中动脉区域有广泛的水肿性梗死。经食管超声心动图观察到胸主动脉夹层，怀疑是由于胸主动脉夹层壁血栓导致脑栓塞。病例2：一名67岁女性，出现意识障碍、左侧空间忽视和左侧偏瘫，于第15天入住我院。第15天的脑部CT扫描显示大脑中动脉区域有非水肿性梗死。第31天的胸部CT增强扫描显示胸主动脉夹层。未观察到临床症状加重，但第94天的脑部CT扫描显示大脑中动脉和前动脉区域有广泛梗死。认为胸主动脉夹层的假腔导致了右侧颈内动脉闭塞。对于不明原因卒中的病例，应考虑行经食管超声心动图或胸部CT增强扫描以检测胸主动脉夹层。
