Mizukami Shuki, Hashiguchi Akihito, Sasaki Kensuke, Moroki Koichi, Tokuda Hajime
Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN.
Cureus. 2024 Jul 1;16(7):e63567. doi: 10.7759/cureus.63567. eCollection 2024 Jul.
Syncope is a common clinical entity with variable presentations and often an elusive causal mechanism, even after extensive evaluation. In any case, global cerebral hypoperfusion, resulting from the inability of the circulatory system to maintain blood pressure (BP) at the level necessary to supply blood to the brain efficiently, is the final pathway for syncope. Steno-occlusive carotid artery disease, even if bilateral, does not usually cause syncope. However, the patient presented here had repeated syncope attacks and underwent a thorough examination for suspected cardiac disease, but no abnormality was found. Since there was severe stenosis in the right unilateral internal carotid artery (ICA), but no stenosis in the left ICA or vertebrobasilar artery (VBA), and transient left mild hemiparesis associated with syncope, carotid revascularization surgery for the right ICA was performed, and the repeated syncope attacks completely disappeared after the surgery. The patient's condition improved markedly, and no further episodes of syncope have been reported. We report the relationship between carotid artery stenosis and syncope and discuss its pathomechanism.
晕厥是一种常见的临床病症，表现多样，即使经过广泛评估，其病因机制往往也难以捉摸。在任何情况下，循环系统无法将血压（BP）维持在有效向大脑供血所需的水平而导致的全脑灌注不足，是晕厥的最终途径。颈动脉狭窄闭塞性疾病，即使是双侧的，通常也不会导致晕厥。然而，本文介绍的患者反复出现晕厥发作，并针对疑似心脏病进行了全面检查，但未发现异常。由于右侧单侧颈内动脉（ICA）存在严重狭窄，而左侧ICA或椎基底动脉（VBA）无狭窄，且晕厥伴有短暂性左侧轻度偏瘫，因此对右侧ICA进行了颈动脉血运重建手术，术后反复晕厥发作完全消失。患者病情明显改善，未再报告晕厥发作。我们报告颈动脉狭窄与晕厥之间的关系并讨论其发病机制。
