CHU Clermont-Ferrand, Neurology Department, 58, rue Montalembert, 63003 Clermont-Ferrand, France; University Clermont 1, UFR Medicine, EA 7980, 28, place Henri-Dunant, 63003 Clermont-Ferrand, France.
CHU Clermont-Ferrand, Neurology Department, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
Rev Neurol (Paris). 2018 Mar;174(3):157-161. doi: 10.1016/j.neurol.2017.06.017. Epub 2017 Nov 15.
The present report is of two patients who, immediately after internal carotid endarterectomy, presented with unexplained hemiplegia, despite normal findings on repeated MRI scans, which secondarily evolved into homolateral subacute corticobasal syndrome (CBS), with asymmetrical hemispheric hypometabolism and evidence of dopaminergic denervation. This prompted us to propose an hypothesis of transient cerebral hypoxia arising during the surgical clamping period that might have provoked a prolonged or permanent functional lesion of the left hemisphere and basal ganglia, with no visible infarction on MRI but only synaptic rearrangement of the neural networks, thereby revealing or exacerbating a potentially preexisting silent impairment.
本报告介绍了两名患者，他们在颈内动脉内膜切除术（carotid endarterectomy）后立即出现不明原因的偏瘫，尽管重复 MRI 扫描未见异常，但随后发展为同侧亚急性皮质基底节综合征（corticobasal syndrome，CBS），表现为不对称的半球低代谢和多巴胺能神经支配丧失的证据。这促使我们提出一个假设，即在手术夹闭期间可能发生短暂的脑缺氧，从而导致左侧大脑半球和基底节的功能损伤持久或永久性，MRI 上无可见梗死，但只有神经网络的突触重排，从而揭示或加重潜在的、先前存在的无症状损害。
