Duke University School of Medicine, Durham, N.C., USA.
Med Princ Pract. 2014;23(1):86-8. doi: 10.1159/000351694. Epub 2013 Jul 26.
To report a case of a hyperdense posterior cerebral artery (PCA) sign in the setting of spontaneous vertebral artery dissection.
A 28-year-old, previously healthy female presented with rapidly progressive coma. A noncontrast computerized tomographic (CT) scan showed a hyperdense PCA sign, which prompted an urgent arteriogram. She was found to have spontaneous vertebral artery dissection with an occluding thrombus. She underwent intra-arterial thrombolysis with tissue plasminogen activator. Follow-up magnetic resonance imaging showed an area of acute infarction in the medial temporal and occipital regions corresponding to the area supplied by the left PCA. The patient was started on systemic anticoagulation therapy with intravenous heparin. She showed slow and continued recovery but was left with significant neurological deficits that required posthospital discharge to a long-term rehabilitation facility.
This case showed that the hyperdense PCA sign on a noncontrast CT scan necessitated an emergent CT angiogram that showed vertebral artery dissection and a devastating vascular occlusion. Hence, we suggest an early intervention that may allow for potential revascularization therapy.
报告自发性椎动脉夹层时出现高密度大脑后动脉（PCA）征的病例。
一名 28 岁、既往健康的女性因迅速进展性昏迷就诊。非增强计算机断层扫描（CT）显示高密度 PCA 征，提示紧急进行血管造影。发现患者存在自发性椎动脉夹层伴闭塞性血栓。给予组织型纤溶酶原激活剂的动脉内溶栓治疗。随访磁共振成像显示内侧颞叶和枕叶区域存在急性梗死，与左侧 PCA 供血区相对应。患者开始接受静脉肝素全身抗凝治疗。她的恢复缓慢且持续，但仍存在严重的神经功能缺损，需要出院后到长期康复机构进行治疗。
本病例表明，非增强 CT 扫描上的高密度 PCA 征需要紧急进行 CT 血管造影，以显示椎动脉夹层和严重的血管闭塞。因此，我们建议早期干预可能允许潜在的血管再通治疗。
