Department of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia.
Neurol Neurochir Pol. 2012 Nov-Dec;46(6):595-9. doi: 10.5114/ninp.2012.31605.
A middle-aged man with pain in the right eye and right side of the neck was brought to the emergency department one hour after the onset of left-sided weakness. Computed tomography (CT) showed hyperdense right middle cerebral artery (MCA). On transcranial Doppler (TCD), occlusion of the right MCA and right internal carotid artery (ICA) was found. Thirty minutes after thrombolytic therapy was initiated, engagement of collateral circulation through the anterior communicating artery (AComA) was shown by TCD. Caro-tid duplex examination confirmed occlusion of the right ICA with intimal flap and intramural haematoma. CT angiography revealed flame-like occlusion of the right ICA, and occlusion of the right MCA with collateral supply from the left to right anterior cerebral artery through the AComA. Recanalization of the MCA and ICA was evident on both CT and ultrasound. Frequent ultrasound monitoring is useful for haemodynamic evaluation of carotid artery dissection, while TCD plays an important role in real-time monitoring of flow changes of intracranial vasculature.
一位中年男性，左眼和右侧颈部疼痛，左侧无力发作后 1 小时被送往急诊部。计算机断层扫描（CT）显示右侧大脑中动脉（MCA）高密度。经颅多普勒（TCD）检查发现右侧 MCA 和右侧颈内动脉（ICA）闭塞。溶栓治疗开始 30 分钟后，TCD 显示前交通动脉（AComA）通过侧支循环的连接。颈动脉双功能超声检查证实右侧 ICA 闭塞，伴有内膜瓣和壁内血肿。CT 血管造影显示右侧 ICA 呈火焰状闭塞，右侧 MCA 闭塞，通过 AComA 从左侧前交通动脉向右侧提供侧支循环。MCA 和 ICA 的再通在 CT 和超声上均可见。颈动脉夹层的血流动力学评估中，频繁的超声监测很有用，而 TCD 在颅内血管血流变化的实时监测中发挥着重要作用。
