Buge A, Vincent D, Rancurel G, Baudrimont M, Dubas F, Hauw J J
Rev Neurol (Paris). 1985;141(8-9):578-82.
A 73 year-old man experienced left monocular blindness and transient right hand clumsiness. A left carotid arteriogram was performed 4 days after admission. Immediately following arteriography, there was a right hemiparesia and dysphasia. After 24 hours, the abnormalities resolved. The patient was treated with heparin. During the following weeks, he became gradually drowsy and confused. Pseudo-bulbar palsy and astasia appeared after a fluctuating but progressive neurological course. The combination of systemic symptoms, high sedimentation rate, renal failure, livedo reticularis and purple toes suggested necrotizing angiitis. With corticosteroid treatment, there was a slight improvement of systemic symptoms. Cholesterol emboli were seen in both fundi. Cholesterol embolization was proved by identifying the biconcave cholesterol crystal clefts in muscle and skin biopsies. The subsequent course was marqued by continuous neurological deterioration. The patient became stuporous and died 7 months after admission. Despite the lack of central nervous system pathological study, the clinical picture was highly suggestive of cerebral cholesterol embolism. A few cases have been reported, with only eight well-documented clinical descriptions. Clinical signs and symptoms were closely similar to those of the present case. Anticoagulant therapy of cholesterol emboli has been unsuccessful. In the present case, the onset of embolization was temporally related to anticoagulation.
一名73岁男性出现左侧单眼失明和右手短暂笨拙。入院4天后进行了左侧颈动脉血管造影。血管造影后立即出现右侧偏瘫和失语。24小时后，异常情况消失。患者接受了肝素治疗。在接下来的几周里，他逐渐变得嗜睡和神志不清。在经历了波动但呈进行性的神经病程后，出现了假性球麻痹和站立不能。全身症状、血沉加快、肾衰竭、网状青斑和紫趾的组合提示为坏死性血管炎。使用皮质类固醇治疗后，全身症状略有改善。双眼眼底均可见胆固醇栓子。通过在肌肉和皮肤活检中识别双凹形胆固醇晶体裂隙，证实了胆固醇栓塞。随后的病程以持续的神经功能恶化为特征。患者入院7个月后昏迷并死亡。尽管缺乏中枢神经系统病理研究，但临床表现高度提示脑胆固醇栓塞。已有少数病例报道，仅有8例有充分记录的临床描述。临床体征和症状与本病例密切相似。胆固醇栓子的抗凝治疗未成功。在本病例中，栓塞的发生在时间上与抗凝有关。
