Brinjikji Waleed, Graffeo Christopher S, Perry Avital, Zimmerman Terence, Janus Jeffrey R, Morris Pearce P, Cascino Gregory D, Lanzino Giuseppe
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
J Neurointerv Surg. 2017 Jul;9(7):e28. doi: 10.1136/neurintsurg-2016-012827.rep. Epub 2017 Jan 6.
A 60-year-old man presented with a 10-month history of of stereotypical spells characterized by vertigo, tinnitus, blurred vision, left hemibody numbness, and occasional syncope, precipitated by turning his head leftwards. Cerebral angiography and CT angiography of the head and neck with provocative maneuvers did not demonstrate vertebral artery narrowing. However, there was narrowing of the left internal jugular vein due to extrinsic compression from the sternocleidomastoid with leftward head rotation in the setting of hypoplasia of the right internal jugular vein. The patient underwent a cervical venogram which confirmed the finding. Manometric evaluation demonstrated a gradient of 29 mm Hg across the stenosis with the head turned leftwards compared with 1 mm Hg in the neutral position. The patient was treated with myectomies of the left sternocleidomastoid, posterior belly of the digastric, stylohyoid and omohyoid and styloid process removal. Following surgery, the patient reported complete resolution of symptoms. Repeat venography demonstrated resolution of the stenosis and pressure gradient.
一名60岁男性，有10个月的刻板发作病史，其特点为眩晕、耳鸣、视力模糊、左侧半身麻木，偶尔晕厥，向左转头可诱发。头颈部脑血管造影及CT血管造影加激发动作未显示椎动脉狭窄。然而，由于右侧颈内静脉发育不全，在向左转头时，左侧颈内静脉受到胸锁乳突肌的外部压迫而狭窄。患者接受了颈部静脉造影，证实了这一发现。压力测量评估显示，向左转头时狭窄处的压力梯度为29 mmHg，而中立位时为1 mmHg。患者接受了左侧胸锁乳突肌、二腹肌后腹、茎突舌骨肌和肩胛舌骨肌切除术及茎突切除术。术后，患者报告症状完全缓解。重复静脉造影显示狭窄及压力梯度消失。
