Brown Samantha J, Nikolova Jennifer, Nitu Monica, Cramer Justin, Dumitrascu Oana
Mayo Clinic Alix School of Medicine, Scottsdale.
Department of Neurology.
Neurologist. 2025 Jul 1;30(4):257-260. doi: 10.1097/NRL.0000000000000610.
Although primarily supplied by the vertebrobasilar system, the hippocampus is partially supplied by ipsilateral carotid artery branches through the anterior choroidal artery or a prominent posterior communicating artery. We report a patient with acute hippocampus infarction likely due to symptomatic ipsilateral tandem carotid stenosis and discuss acute vascular-mediated hippocampal injury.
An 80-year-old female with obesity, dyslipidemia, hypertension, alcohol use disorder, history of breast cancer on letrozole, and traumatic brain injury was brought into our emergency department for 24 hours of confusion. On examination, she exhibited limited registration, recall, and executive dysfunction with otherwise normal language, visuo-spatial orientation, and praxis. Brain MRI showed a small area of diffusion restriction in the anterior right hippocampus with matched FLAIR hyperintensity, consistent with acute infarction. Computed tomography angiogram head and neck showed 90% stenosis of the proximal right internal carotid artery (ICA), <50% narrowing of the proximal left ICA, and moderate bilateral narrowing of the paraclinoid ICAs, all due to calcific atheromatous plaques. The etiology of the hippocampal infarction was suspected embolism from the ipsilateral severe carotid stenosis. Planning for right cervical carotid revascularization ensued.
This case highlights the dual hippocampal vascular supply and that hippocampal embolic infarcts could be a sign of a symptomatic severe carotid artery stenosis that may require urgent revascularization for stroke secondary prevention.
尽管海马主要由椎基底动脉系统供血，但同侧颈动脉分支可通过脉络膜前动脉或粗大的后交通动脉为海马部分供血。我们报告一例可能因症状性同侧串联颈动脉狭窄导致急性海马梗死的患者，并讨论急性血管介导的海马损伤。
一名80岁女性，患有肥胖症、血脂异常、高血压、酒精使用障碍、正在服用来曲唑治疗乳腺癌且有创伤性脑损伤史，因意识模糊24小时被送至我院急诊科。检查发现，她存在有限的注意力、记忆力和执行功能障碍，而语言、视觉空间定向和运用能力正常。脑部MRI显示右侧前海马有一小片扩散受限区域，FLAIR序列呈相应高信号，符合急性梗死表现。头颈CT血管造影显示右侧颈内动脉近端狭窄90%，左侧颈内动脉近端狭窄<50%，双侧海绵窦段颈内动脉中度狭窄，均由钙化性动脉粥样硬化斑块所致。怀疑海马梗死的病因是同侧严重颈动脉狭窄导致的栓塞。随后计划进行右侧颈颈动脉血运重建术。
本病例突出了海马的双重血管供应，且海马栓塞性梗死可能是症状性严重颈动脉狭窄的一个迹象，可能需要紧急血运重建以进行卒中二级预防。
