Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Viale Mario Bracci, 16, 53100, Siena, Italy.
Unit of Interventional Neuroradiology, Department of Neurology and Human Movement Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy.
J Ultrasound. 2023 Dec;26(4):771-776. doi: 10.1007/s40477-022-00686-z. Epub 2022 Apr 28.
We report the case of a young woman affected by an aneurysmal subarachnoid haemorrhage (SAH) and numerous anatomic abnormalities. A Transcranial Colour-Coded Duplex Sonography, performed with the aim of monitoring the vasospasm, showed a non-pulsatile flow with loss of sharp systolic peak and lowering of mean flow velocities in the right extracranial Internal Carotid Artery (ICA) and all its intra-cranial branches. This event suggested a possible concomitant acute right ICA sub-occlusion with a lack of collateral circulation. This type of flow is typically found in systemic and brain arteries of patients undergoing to venous-arterial extracorporeal membrane oxygenation or to left ventricular assist devices. The absence of an adequate cerebral collateral circulation might be the explanation for this type of atypical flow. Aneurysms and arterial dissections contribute to SAH and ischemic stroke events, leading to long-term physical and cognitive disability. In our case, the prompt neurosonological diagnosis leaded to patient's good outcome.
我们报告了一例年轻女性患有颅内动脉瘤性蛛网膜下腔出血（SAH）和多种解剖异常的病例。为了监测血管痉挛，我们进行了经颅彩色双功能超声检查，结果显示右侧颈外动脉（ICA）及其所有颅内分支的非搏动性血流丧失了尖锐的收缩峰，平均血流速度降低。这一事件提示可能同时发生右侧 ICA 亚闭塞，伴有侧支循环不足。这种类型的血流通常见于接受静脉-动脉体外膜肺氧合或左心室辅助装置治疗的系统性和脑动脉患者。缺乏足够的脑侧支循环可能是这种非典型血流的解释。动脉瘤和动脉夹层导致蛛网膜下腔出血和缺血性卒中事件，导致长期的身体和认知残疾。在我们的病例中，及时的神经超声诊断导致了患者的良好结局。
