Matsumoto H, Moriwaki H, Masuo O, Terada T, Itakura T
Department of Neurological Surgery, Hidaka General Hospital, Japan.
No Shinkei Geka. 2000 Jun;28(6):541-5.
A 57-year-old female was admitted to our hospital because of headache, nausea, and vomiting. Head CT scan demonstrated subarachnoid hemorrhage. Cerebral angiography showed the absence of the right internal carotid artery, and skull base CT of the bone window level revealed the absence of the right carotid canal. The right middle cerebral artery (MCA) and anterior cerebral artery (ACA) were opacified from the left internal carotid artery. The right A1 portion was hypoplastic and the distal portion of the right M1 portion was replaced by several minute complicated anastomotic vessels connected to the right M2 portion. The right MCA territory was mainly supplied by collateral flow from the right ACA and the right posterior cerebral artery via the leptomeningeal anastomosis. These was neither aneurysm nor arteriovenous malformation. The second angiography, 1 week after the initial angiography, showed the same hemodynamic pattern and aneurysms were not found. We diagnosed the patient as agenesis of the right internal carotid artery and the etiology of subarachnoid hemorrhage was suspected to be a rupture of the anastomotic vessels between the right M1 and M2. She was discharged on the 21st hospital day without any neurological deficit.
一名57岁女性因头痛、恶心和呕吐入院。头部CT扫描显示蛛网膜下腔出血。脑血管造影显示右侧颈内动脉缺如，骨窗位的颅底CT显示右侧颈动脉管缺如。右侧大脑中动脉（MCA）和大脑前动脉（ACA）由左侧颈内动脉显影。右侧A1段发育不良，右侧M1段远端由连接至右侧M2段的数条微小复杂吻合血管替代。右侧MCA供血区主要由右侧ACA和右侧大脑后动脉通过软脑膜吻合形成的侧支循环供血。既没有动脉瘤也没有动静脉畸形。初次血管造影1周后的第二次血管造影显示血流动力学模式相同，未发现动脉瘤。我们诊断该患者为右侧颈内动脉缺如，蛛网膜下腔出血的病因怀疑是右侧M1和M2之间吻合血管破裂。患者于住院第21天出院，无任何神经功能缺损。
