Michel D, Pialat J, Antoine J C, Laurent B, Convers P
Service de Neurologie, Hôpital Bellevue, Saint-Etienne.
Rev Neurol (Paris). 1988;144(1):25-31.
A 64 year old patient with a cardiac prosthesis and receiving antivitamin K therapy presented with a right bulbar syndrome. Based on absence of meningeal signs and hemorrhage on CT scan heparin therapy was instituted. Fatal coma developed two and a half days later. Autopsy findings included a right lateral bulbar infarct and meningeal hemorrhage, predominant around a fusiform dilatation of the end of the right vertebral artery. Serial sections showed a large dissecting aneurysm between media and adventitia communicating with an intimal tear. Among intracranial dissecting aneurysms those of vertebrobasilar localization have the peculiarity of being subadventitial in some cases, with a subsequent enhanced risk of hemorrhagic complications. The use of anticoagulants appears contraindicated in these cases, even if their clinical expression is suggestive of an infarct. Their etiology is often unknown.
一名64岁的患者装有心脏假体且正在接受抗维生素K治疗，出现了右侧延髓综合征。基于CT扫描未发现脑膜刺激征和出血，开始了肝素治疗。两天半后出现致命性昏迷。尸检结果包括右侧延髓梗死和脑膜出血，主要围绕右椎动脉末端的梭形扩张。连续切片显示中膜和外膜之间有一个大的夹层动脉瘤，与内膜撕裂相通。在颅内夹层动脉瘤中，椎基底动脉定位的动脉瘤在某些情况下具有外膜下的特点，随后出血并发症的风险增加。在这些病例中，即使临床表现提示梗死，使用抗凝剂似乎也是禁忌的。其病因往往不明。
