Kunishio K, Sunami N, Yamamoto Y, Asari S
No Shinkei Geka. 1986 Jun;14(7):873-9.
A case of agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with multiple cerebral aneurysms is presented. No similar case has been reported before. A 70-year-old man who had severe headache was admitted to the neurological department of Matsuyama Shimin Hospital. On admission he demonstrated nuchal rigidity and motor aphasia. CT scan revealed subarachnoid hemorrhage with intracerebral hematoma in the left temporal area. Right common carotid angiography, bilateral retrograde brachial angiography and aortography demonstrated an agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with aneurysms of the anterior communicating artery, left middle cerebral artery and basilar tip. And these revealed that the left middle cerebral artery was fed from the basilar artery via the dilated left posterior communicating artery, and the left ophthalmic artery was originated from the left middle cerebral artery. CT of the base of the skull revealed no carotid canal on the left side. We confirmed these findings by operation. The importance of altered hemodynamic forces on the circle of Willis produced by the agenesis of the internal carotid artery and the embryological considerations are discussed.
本文报道了一例左侧颈内动脉、颈总动脉及颈外动脉主干缺如并伴有多发性脑动脉瘤的病例。此前未见类似病例报道。一名70岁男性因剧烈头痛入住松山市民医院神经科。入院时，他表现出颈项强直和运动性失语。CT扫描显示左侧颞叶蛛网膜下腔出血并伴有脑内血肿。右侧颈总动脉造影、双侧逆行肱动脉造影及主动脉造影显示左侧颈内动脉、颈总动脉及颈外动脉主干缺如，同时伴有前交通动脉、左侧大脑中动脉及基底动脉尖部的动脉瘤。这些检查还显示左侧大脑中动脉通过扩张的左侧后交通动脉由基底动脉供血，左侧眼动脉起源于左侧大脑中动脉。头颅底部CT显示左侧无颈动脉管。我们通过手术证实了这些发现。文中讨论了颈内动脉缺如对Willis环血流动力学改变的影响以及胚胎学方面的考虑。
