Department of Neurology, Osaka Neurological Institute, Osaka, Japan.
J Stroke Cerebrovasc Dis. 2012 Nov;21(8):918.e7-8. doi: 10.1016/j.jstrokecerebrovasdis.2012.05.014. Epub 2012 Jun 27.
We report a case of internal carotid artery (ICA) occlusion caused by arterial dissection triggered by an elongated styloid process. A 43-year-old man presented with a headache followed by speech disturbance. Magnetic resonance imaging and magnetic resonance angiography scans revealed acute infarction and right ICA occlusion. A T1-weighted magnetic resonance imaging scan revealed a hyperintensity in the occluded ICA, suggesting intramural hematoma. Computed tomographic angiography also revealed ICA occlusion and bilateral elongated styloid processes. We performed transoral carotid ultrasonography, which revealed the absence of flow signal in the double lumen of the dilated extracranial ICA. We diagnosed his condition as arterial dissection and treated him with antithrombotic drugs. Six months later, the occluded ICA recanalized spontaneously, and computed tomographic angiography at that time revealed a close relation between the tip of the styloid process and the recanalized ICA. This finding suggests that an elongated styloid process is involved in arterial dissection. In patients with ICA occlusion of unknown etiology, an evaluation for intramural hematoma and styloid process length are useful for the diagnosis of dissection and its etiology.
我们报告一例由延长的茎突引起的动脉夹层导致的颈内动脉（ICA）闭塞。一名 43 岁男性因头痛伴言语障碍就诊。磁共振成像和磁共振血管造影扫描显示急性梗死和右侧 ICA 闭塞。T1 加权磁共振成像扫描显示闭塞的 ICA 呈高信号，提示壁内血肿。计算机断层血管造影也显示 ICA 闭塞和双侧延长的茎突。我们进行了经口颈动脉超声检查，显示扩张的颅外 ICA 双腔无血流信号。我们诊断为动脉夹层，并给予抗血栓药物治疗。6 个月后，闭塞的 ICA 自发性再通，此时计算机断层血管造影显示茎突尖端与再通的 ICA 关系密切。这一发现提示延长的茎突与动脉夹层有关。对于不明原因的 ICA 闭塞患者，评估壁内血肿和茎突长度有助于诊断夹层及其病因。
