Department of Neurology, General Hospital «Prim.dr. Abdulah Nakas», Sarajevo, Bosnia and Herzegovina.
Med Arch. 2020 Feb;74(1):58-60. doi: 10.5455/medarh.2020.74.58-60.
Dolichoarteriopathies of the internal carotid artery (DICAs) is divided into three forms: tortuous, coiling and kinking. In case of kinking, internal carotid artery forms a sharp angle of <90 degrees, while in the background there is metaplasia of a tunica media with unknown etiology. The association with stroke is still questionable, but it is believed that it can be associated with cerebral ischemia and with clinical symptomatology that accompanies cerebral ischemia.
Aim of article was to present diagnostic and therapeutic modality of patient with verified internal carotid artery kinking.
The 55-year-old male patient was admitted to the Department of Neurology, General Hospital «Prim.dr. Abdulah Nakas», due to dizziness and instability while walking, forgetfulness, memory loss and low mood. He has previously been reported to be hypertensive and with diagnosis of diabetes mellitus and dyslipidemia. Doppler sonography also suspects on distal subocclusion of the internal carotid artery (low flow rates were observed). Diagnostic transcranial Doppler (TCD) of vertebrobasilar artery showed decreased blood flow velocities in both vertebral and basilar artery and indicated atherosclerotic altered blood vessels of the brain. CTA findings indicate bilateral kinking of internal carotid artery with right duplex Kinking. SPECT with 15 mCi 99mTc-hexamethylpropyleneamineoxime (99mTc-HMPAO) verified global cortex hypoperfusion, indicating chronic vascular failure. The patient was treated with acetylsalic acid, clopidogrel, atorvastatin, donepezil, memantine, escitalopram, bromazepam, along with antihypertensive and antidiabetic therapy (per os).
A severe degree of kinking can cause neurological symptomatology, especially if it is bilateral. Symptoms of cerebrovascular disease are more pronounced when autoregulation of cerebral hemodynamics is impaired. Bilateral severe degree of kinking possibly can cause cognitive impairment. Diagnosis, analysis of the existence of possible risk factors for the onset, and the existence of genetic predisposition are a prerequisite for better understanding of the disease and optimal treatment.
颈内动脉的迂曲、卷曲和扭转（DICAs）分为三种形式：迂曲、卷曲和扭转。在扭转的情况下，颈内动脉形成小于 90 度的锐角，而在背景中存在中膜的化生，其病因不明。与中风的关联仍存在疑问，但据信它可能与脑缺血以及伴随脑缺血的临床症状有关。
本文旨在介绍已确诊的颈内动脉扭转患者的诊断和治疗方法。
55 岁男性患者因头晕和行走不稳、健忘、记忆力减退和情绪低落，入住 General Hospital «Prim.dr. Abdulah Nakas» 神经内科。他之前曾被报告患有高血压，并被诊断为糖尿病和血脂异常。多普勒超声检查也怀疑颈内动脉远端闭塞（观察到低血流速度）。颅多普勒（TCD）诊断椎基底动脉显示双侧椎动脉和基底动脉血流速度降低，并提示脑动脉粥样硬化改变。CTA 检查结果表明双侧颈内动脉扭曲，右侧为双工扭转。使用 15mCi 99mTc-六甲基丙烯酰胺肟（99mTc-HMPAO）进行 SPECT 检查，证实全脑皮层灌注减少，表明慢性血管衰竭。患者接受了乙酰水杨酸、氯吡格雷、阿托伐他汀、多奈哌齐、美金刚、依西酞普兰、溴西泮治疗，同时还接受了降压和降糖治疗。
严重程度的扭转可能导致神经症状，特别是如果是双侧的。当脑血液动力学自动调节受损时，脑血管病的症状更为明显。双侧严重程度的扭转可能导致认知障碍。诊断、分析发病的可能危险因素、遗传易感性的存在，是更好地理解疾病和优化治疗的前提。
