Zuluaga-Gómez Mateo, Giraldo-Campillo Daniela, González-Arroyave Daniel, Ardila Carlos M
Hospital San Vicente Fundación, Rionegro, Colombia.
Profesor Universidad Bolivariana, Medellín, Colombia.
Case Rep Med. 2022 Oct 18;2022:9365947. doi: 10.1155/2022/9365947. eCollection 2022.
Vertebral artery dissection is a common cause of stroke in young adults without predisposing risk factors for cerebrovascular disease. We describe the case of a 28-year-old patient who presented with an ischemic stroke secondary to a stab wound to the neck that affected the vertebral artery. A physical examination revealed neurological deterioration (Glasgow 8/15), a sutured neck wound, no palpable hematoma, no thrills, and no active bleeding. A computed tomography angiography revealed a left vertebral artery arteriovenous fistula with a component of a pseudoaneurysm, for which a neurointerventional consultation was carried out. Due to neurological compromise, the airway was secured, and because the case involved a posterior fossa infarction with compression of the fourth ventricle and obstructive secondary hydrocephalus, an external ventricular shunt was inserted by neurosurgery. A fistula occlusion was performed with five Axium coils and a vial of Squid 12; the vertebral artery was catheterized, and a craniotomy was performed to manage hydrocephalus with a 12-mm HO collecting system. The patient was discharged on the tenth day after admission with sequelae of left hemiparesis (predominantly brachial) and no other deficits. There was no hemorrhagic transformation on the control computed tomography scans and no further complications.
椎动脉夹层是无脑血管疾病易感危险因素的年轻成年人中风的常见原因。我们描述了一例28岁患者的病例，该患者因颈部刺伤累及椎动脉而出现缺血性中风。体格检查发现神经功能恶化（格拉斯哥评分8/15）、颈部有缝合伤口、未触及血肿、无震颤且无活动性出血。计算机断层血管造影显示左椎动脉动静脉瘘伴假性动脉瘤成分，为此进行了神经介入会诊。由于神经功能受损，确保了气道安全，并且由于该病例涉及后颅窝梗死伴第四脑室受压和继发性梗阻性脑积水，神经外科插入了外置脑室引流管。使用5个Axium线圈和一小瓶Squid 12进行了瘘管闭塞；对椎动脉进行了插管，并进行了开颅手术，使用12毫米HO收集系统处理脑积水。患者在入院后第10天出院，遗留左侧偏瘫（主要是臂部）后遗症，无其他缺陷。对照计算机断层扫描未发现出血转化，也无进一步并发症。
