Mitani Yuta, Kobayashi Zen, Hattori Eijiro, Numasawa Yoshiyuki, Ishihara Shoichiro, Tomimitsu Hiroyuki, Shintani Shuzo
Department of Neurology, JA Toride Medical Center, Japan.
Department of Cardiology, JA Toride Medical Center, Japan.
J Rural Med. 2021 Apr;16(2):123-125. doi: 10.2185/jrm.2020-064. Epub 2021 Apr 1.
Brachiocephalic artery stenosis rarely causes right hemispheric infarction with associated left hemiparesis. To date, there have been no reported cases of stroke associated with brachiocephalic artery stenosis that were successfully treated with recombinant tissue-type plasminogen activator (rt-PA), alteplase. An 80-year-old woman presented with left hemiparesis. Brain computed tomography showed no hemorrhage, and computed tomography angiography demonstrated brachiocephalic artery stenosis. Alteplase was administered based on a diagnosis of ischemic stroke. Brain magnetic resonance imaging showed multiple acute infarctions. Thereafter, the blood pressure of the right arm was found to be lower than that of the left arm. The patient's neurological deficits gradually improved; she was eventually able to walk again and was thus discharged home. While the combination of left hemiparesis and a decrease in blood pressure in the right arm are well known in patients with stroke associated with Stanford type A aortic dissections, it may also occur in patients with stroke due to brachiocephalic artery stenosis. Unlike stroke associated with Stanford type A aortic dissections, stroke due to brachiocephalic artery stenosis may be treated with alteplase.
头臂动脉狭窄很少导致伴有左侧偏瘫的右侧半球梗死。迄今为止，尚无头臂动脉狭窄相关的中风病例成功接受重组组织型纤溶酶原激活剂（rt-PA）阿替普酶治疗的报道。一名80岁女性出现左侧偏瘫。脑部计算机断层扫描未显示出血，计算机断层扫描血管造影显示头臂动脉狭窄。基于缺血性中风的诊断给予阿替普酶治疗。脑部磁共振成像显示多处急性梗死。此后，发现右臂血压低于左臂。患者的神经功能缺损逐渐改善；她最终能够再次行走，因此出院回家。虽然在与斯坦福A型主动脉夹层相关的中风患者中，左侧偏瘫和右臂血压降低的组合很常见，但在头臂动脉狭窄导致的中风患者中也可能出现。与斯坦福A型主动脉夹层相关的中风不同，头臂动脉狭窄导致的中风可能用阿替普酶治疗。
