Nakano Hidehiko, Yamagami Hiroshi, Ofuchi Hisashi
Emergency Department Shonan Kamakura General Hospital Kamakura Kanagawa Japan.
Acute Med Surg. 2016 Aug 25;4(1):127-130. doi: 10.1002/ams2.235. eCollection 2017 Jan.
An 82-year-old woman who had atrial fibrillation was found unconscious and was brought to the emergency department by ambulance. Her Glasgow Coma Scale score was 3, and an electrocardiogram showed ST segment elevation in V3 and V4. Cardiac ultrasonography showed left ventricular asynergy in the anterior wall, septum, and apex. Although dissection of the aorta was suspected, contrast computed tomography showed multiple arterial thromboses, including bilateral common carotid arteries and poor contrast in the left ventricle. Diffusion-weighted images of magnetic resonance imaging showed a diffuse high-intensity area in both cerebral cortices.
The diagnosis was multiple arterial thromboembolisms associated with atrial fibrillation. There was no available treatment because of massive multiple lesions and the patient died within 24 h of presentation.
Extracranial systemic embolic events other than cerebral embolism could be critical complications associated with atrial fibrillation.
一名82岁患心房颤动的女性被发现昏迷，由救护车送至急诊科。她的格拉斯哥昏迷量表评分为3分，心电图显示V3和V4导联ST段抬高。心脏超声检查显示前壁、室间隔和心尖部左心室运动不协调。尽管怀疑有主动脉夹层，但计算机断层扫描血管造影显示多处动脉血栓形成，包括双侧颈总动脉，且左心室造影剂充盈不佳。磁共振成像的弥散加权图像显示双侧大脑皮质有弥漫性高强度区域。
诊断为与心房颤动相关的多发性动脉血栓栓塞。由于存在大量多发性病变，没有可用的治疗方法，患者在就诊后24小时内死亡。
除脑栓塞外，颅外系统性栓塞事件可能是与心房颤动相关的严重并发症。
