Maeda Kouichirou, Yasaka Masahiro, Wakugawa Yoshiyuki, Ogata Toshiyasu, Okada Yasushi
Department of Cerebrovascular Disease, Clinical Research Center, National Hospital Organization Kyushu Medical Center.
Rinsho Shinkeigaku. 2009 Feb-Mar;49(2-3):104-8. doi: 10.5692/clinicalneurol.49.104.
A 63-year-old man was admitted because of sudden transient consciousness disturbance and left-side hemiparesis 110 minutes after the onset. Typical symptoms of aortic dissection, such as chest pain, back pain, neck pain, laterality of blood pressure or hypotension were not found. Brain magnetic resonance imaging (MRI) showed multiple acute brain infarction of the right middle cerebral artery territory. Carotid duplex ultrasonography demonstrated a subintimal dissection with a false channel of the right common carotid artery (CCA) and the right internal carotid artery (ICA). Thoracoabdominal computed tomographic (CT) scan demonstrated the false lumen in ascending and descending thoracic aorta. Cervical CT scan showed a dissection with a false channel of the right CCA. Intravenous administration of recombinant tissue plasminogen activator (rt-PA) is a contraindicant therapy in patients of brain infarction with aortic dissection. Thus our patient showed thoracic aortic dissection with extension of the dissection toward the right internal carotid artery. And the patient complained of neither the pain in the chest, the back nor the neck. So we emphasize the necessity of carotid duplex ultrasonography examination before intravenous administration of rt-PA in the treatment of the cerebral infarction, regardless of having chest pain, back pain, neck pain or not.
一名63岁男性在发病110分钟后因突发短暂意识障碍和左侧偏瘫入院。未发现主动脉夹层的典型症状，如胸痛、背痛、颈部疼痛、血压差异或低血压。脑磁共振成像（MRI）显示右侧大脑中动脉区域多发急性脑梗死。颈动脉双功超声检查显示右侧颈总动脉（CCA）和右侧颈内动脉（ICA）存在内膜下夹层并伴有假腔。胸腹部计算机断层扫描（CT）显示升主动脉和降主动脉存在假腔。颈部CT扫描显示右侧CCA存在伴有假腔的夹层。对于患有主动脉夹层的脑梗死患者，静脉注射重组组织型纤溶酶原激活剂（rt-PA）是禁忌治疗方法。因此，我们的患者表现为胸主动脉夹层并向右侧颈内动脉延伸。并且患者既没有胸痛、背痛也没有颈部疼痛。所以我们强调，在治疗脑梗死时，无论是否有胸痛、背痛、颈部疼痛，在静脉注射rt-PA之前进行颈动脉双功超声检查的必要性。
