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[挥鞭样损伤后颈内动脉创伤性夹层。一种常被忽视但潜在危险的附加血管病变的诊断检查与治疗]

[Traumatic dissection of the internal carotid artery following whiplash injury. Diagnostic workup and therapy of an often overlooked but potentially dangerous additional vascular lesion].

作者信息

Lenz M, Bula-Sternberg J, Koch T, Bula P, Bonnaire F

机构信息

Klinik für Allgemein- und Viszeralchirurgie, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Weißeritztal-Kliniken GmbH, Bürgerstraße 7, 01705, Freital, Deutschland.

出版信息

Unfallchirurg. 2012 Apr;115(4):369-76. doi: 10.1007/s00113-011-2130-7.

Abstract

We report on the case of a 33-year-old male patient who was brought to the emergency room of our hospital after suffering a high-energy trauma due to an automobile accident. Besides a scaphoid fracture there were no signs of any neurological deficits. After several hours without clinical symptoms the patient developed dysarthria as the first manifestation of local cerebral ischemia based on a traumatic dissection of the internal carotid artery. Under systemic high-dose heparin therapy, fast and complete remission of all neurological disorders could be achieved. In the course of time a dissecting aneurysm developed. Temporary anticoagulation with phenprocoumon was started in the meantime and no further complications have appeared up to now. Besides presenting this absorbing case, this article highlights the diagnostic and therapeutic regime in cases of a traumatic dissection of supra-aortal arteries for rapid and adequate management of this rare but potentially dangerous complication.

摘要

我们报告了一名33岁男性患者的病例,该患者因汽车事故遭受高能创伤后被送往我院急诊室。除舟骨骨折外,未发现任何神经功能缺损迹象。在数小时无临床症状后,患者出现构音障碍,这是基于颈内动脉创伤性夹层形成的局部脑缺血的首发表现。在全身大剂量肝素治疗下,所有神经功能障碍均可快速、完全缓解。随着时间推移,形成了一个夹层动脉瘤。与此同时开始使用苯丙香豆素进行临时抗凝,至今未出现进一步并发症。除了呈现这个引人关注的病例外,本文还强调了主动脉弓上动脉创伤性夹层病例的诊断和治疗方案,以便对这种罕见但潜在危险的并发症进行快速、适当的处理。

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