de Campos Fernando Peixoto Ferraz, Kanegae Marcia Yoshie, Aiello Vera Demarchi, Dos Santos Pedro José, Gratão Tatiane Carneiro, Silva Erasmo Simão
University of São Paulo (USP), Hospital Universitário, Internal Medicine Department. São Paulo, SP, Brazil.
University of São Paulo (USP), Heart Institute, School of Medicine, Laboratory of Pathology. São Paulo, SP, Brazil.
Autops Case Rep. 2018 Feb 27;8(1):e2018010. doi: 10.4322/acr.2018.010. eCollection 2018 Jan-Mar.
Central nervous system (CNS) ischemic events, besides being a common and devastating disease, are accompanied by severe disability and other morbidities. The cause of such events is not always that simple to diagnose, and among the young, a broad spectrum of possibilities should be considered. We present the case of a young man who presented two episodes of CNS ischemia with a 1 year gap between them, which occurred in the same situation while he was walking and carrying a heavy backpack. The second event first presented as a transient ischemic attack followed by a stroke the day after. The diagnostic work-up showed an indentation of the greater cornu of the hyoid bone over the internal carotid artery, which injured the media and intimal layers. At the arterial injury site, a micro thrombus was found, which explained the source of the embolic event to the CNS. The patient was operated on, and the procedure included the resection of the posterior horn of the hyoid bone, the resection of the injured segment of the internal carotid artery followed by carotid-carotid bypass with the great saphenous vein. The postoperative period and the recovery were uneventful as was the 5-month follow-up. We call attention to this unusual cause of stroke and present other cases reported in the literature.
中枢神经系统（CNS）缺血性事件不仅是一种常见且具有破坏性的疾病，还伴有严重残疾和其他病症。此类事件的病因并不总是那么容易诊断，对于年轻人而言，应考虑多种可能性。我们报告一例年轻男性病例，其出现了两次中枢神经系统缺血发作，两次发作间隔1年，均发生在他行走并背着沉重背包的相同情况下。第二次事件最初表现为短暂性脑缺血发作，次日继之以中风。诊断检查显示舌骨大角在内颈动脉上方有压痕，损伤了中膜和内膜层。在动脉损伤部位发现了一个微血栓，这解释了栓塞事件至中枢神经系统的来源。患者接受了手术，手术包括切除舌骨后角、切除颈内动脉受损段，随后用大隐静脉进行颈动脉-颈动脉搭桥术。术后恢复顺利，5个月随访情况良好。我们提请注意这种不寻常的中风病因，并介绍文献中报道的其他病例。
