Department of Neurosurgery, Faculty of Medicine, Fukuoka University; and.
Department of Neurology, Fukuoka Red Cross Hospital, Fukuoka, Japan.
J Neurosurg Spine. 2015 Aug;23(2):166-9. doi: 10.3171/2014.11.SPINE14393. Epub 2015 May 1.
Wake-up stroke is most likely to be caused by small-vessel disease, and is related to snoring. The authors present a rare case of far-lateral cervical disc herniation with neck rotation, resulting in wake-up stroke in a young woman. The patient, a 31-year-old woman, was admitted to the hospital because of dysarthria and confusion when she awoke in the morning. Brain MRI showed acute infarction in the posterior fossa. Cerebral angiography showed thrombus in the distal top of the basilar artery and the bilateral posterior cerebral arteries. During angiography, the thrombus size decreased with heparinization. There was severe stenosis of the right vertebral artery (VA) at C5-6, and head rotation to the right resulted in complete occlusion of the right VA. Neck MRI showed far-lateral intervertebral disc herniation. Surgical decompression of the VA was performed via the anterior cervical approach. Histological examination showed a degenerative intervertebral disc. Postoperative angiography confirmed successful decompression of the VA.
唤醒性中风最有可能由小血管疾病引起，与打鼾有关。作者报告了一例罕见的远外侧型颈椎间盘突出症伴颈部旋转导致年轻女性唤醒性中风的病例。患者为 31 岁女性，因清晨醒来时出现构音障碍和意识模糊而入院。脑部 MRI 显示后颅窝急性梗死。脑动脉造影显示基底动脉顶端和双侧大脑后动脉有血栓。在血管造影过程中，随着肝素化，血栓大小减小。C5-6 段右侧椎动脉（VA）严重狭窄，头部向右侧旋转导致右侧 VA 完全闭塞。颈部 MRI 显示远外侧椎间盘突出。通过前路颈椎手术进行 VA 减压。组织学检查显示退行性椎间盘。术后血管造影证实 VA 减压成功。
