Sasaki Takashi, Hori Emiko, Sakai Sotaro, Fuji Tatsushi, Takata Hisashi
Department of Neurosurgery, Takaoka City Hospital, Toyama, Japan.
No Shinkei Geka. 2010 Aug;38(8):739-44.
Traumatic aneurysms are rare lesions. They differ markedly from saccular aneurysms in their clinical presentation and therapy. Early diagnosis of traumatic aneurysms is usually difficult. A 52-year-old female presented with massive epistaxis and ear bleeding caused by a traffic accident. On admission, her consciousness level was 7 points of the Glasgow coma scale. Computed tomography revealed hematoma in the sphenoid sinus and fractures in the right petrous bone, and right acute subdural hematoma. 7 years after trauma, she presented ear bleeding. Cerebral angiography showed a giant traumatic aneurysm at the petrous segment of the right internal carotid artery. Test occlusion of the right internal carotid artery was performed and was well tolerated without development of focal neurological deficits, so the right internal carotid artery was occluded using endovascular techniques. We recommend that more attention be paid to the traumatic aneurysm of the C4 to C5 portion when patients with skull base fracture are diagnosed.
创伤性动脉瘤是罕见的病变。它们在临床表现和治疗方面与囊状动脉瘤有显著差异。创伤性动脉瘤的早期诊断通常很困难。一名52岁女性因交通事故出现大量鼻出血和耳部出血。入院时,她的格拉斯哥昏迷量表评分为7分。计算机断层扫描显示蝶窦血肿、右侧岩骨骨折和右侧急性硬膜下血肿。创伤7年后,她出现耳部出血。脑血管造影显示右侧颈内动脉岩骨段有一个巨大的创伤性动脉瘤。对右侧颈内动脉进行了试验性闭塞,耐受性良好,未出现局灶性神经功能缺损,因此采用血管内技术闭塞了右侧颈内动脉。我们建议,在诊断颅底骨折患者时,应更多关注颈4至颈5段的创伤性动脉瘤。