Venketasubramanian Narayanaswamy, Mundada Pravin, Hegde Amogh Narayan, Tan Marcus, Ng Darren
Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore.
Department of Diagnostic Radiology, Raffles Hospital, Singapore, Singapore.
Case Rep Neurol. 2020 Dec 14;12(Suppl 1):143-148. doi: 10.1159/000504567. eCollection 2020 Sep-Dec.
Cervical artery dissection is a rare complication of head and neck trauma. Though it is an infrequent cause of ischaemic stroke, it is more common among the young with cerebral ischaemia. The usual location of carotid dissection is just beyond the carotid bulb. We report a case of post-traumatic internal carotid dissection that began at the base of the skull after blunt head trauma from a road traffic accident. The patient is a 25-year-old right-handed lady who, 2 days after the accident, developed dysphasia and right-sided limb weakness. She had no significant past medical history. Magnetic resonance imaging (MRI) showed acute ischaemic stroke in the internal watershed regions of the left cerebral hemisphere. MR angiogram revealed focal near-occlusion of the left internal carotid artery at the base of the skull just prior to its entry into the petrous temporal bone. There were no skull fractures. She progressed despite anticoagulation. The location of the site of dissection at the base of the skull is likely due to stresses on the carotid intima at this point during flexion-extension-rotation that occurs during head injury, as this is where the internal carotid artery is tethered to the skull. Rapid recognition of symptoms of cerebral ischaemia among patients with blunt head trauma is needed to allow prompt investigation and institution of relevant therapies.
颈内动脉夹层是头颈部创伤的一种罕见并发症。尽管它是缺血性卒中的少见病因，但在年轻的脑缺血患者中更为常见。颈动脉夹层的常见部位恰好在颈动脉球部之外。我们报告一例创伤后颈内动脉夹层病例，该夹层起自颅骨底部，由道路交通事故导致的钝性头部外伤引起。患者为一名25岁右利手女性，事故发生2天后出现言语困难和右侧肢体无力。她既往无重大病史。磁共振成像（MRI）显示左侧大脑半球内分水岭区急性缺血性卒中。磁共振血管造影显示左侧颈内动脉在进入颞骨岩部之前于颅骨底部处有局灶性近乎闭塞。无颅骨骨折。尽管进行了抗凝治疗，她仍病情进展。夹层部位位于颅骨底部可能是由于头部受伤时屈伸旋转过程中该部位颈内动脉内膜受到的应力所致，因为此处颈内动脉附着于颅骨。需要快速识别钝性头部外伤患者的脑缺血症状，以便及时进行检查并开展相关治疗。
