Laitt R D, Lewis T T, Bradshaw J R
Department of Neuroradiology, Frenchay Hospital, Bristol, UK.
Clin Radiol. 1996 Feb;51(2):117-22. doi: 10.1016/s0009-9260(96)80268-6.
Blunt injury to the carotid arteries in the neck, either by direct or indirect forces, is rare but may produce a devastating outcome with long term morbidity. Injury results in either dissection of the vessel wall or pseudoaneurysm formation. Secondary thromboembolic disease results in cerebral infarction. In a seven year period, from April 1987 to April 1994, 2024 patients with blunt injury to the head and neck were admitted to our institution. In this group eight patients (0.4%) were identified with injury to the carotid arteries, seven with dissection and one with pseudoaneurysm formation. Injury was caused by either hyperextension or lateral hyperflexion of the neck. External signs of trauma to the neck were absent in three patients. In all patients there was an associated head injury. Three suffered transient loss of consciousness and a fourth had a transient ischaemic attack 36 h after the injury. CT brain scans performed at the time of initial injury in these patients were all normal. The remaining four patients had no neurological deficit at initial presentation. In no case was injury to the carotid artery suspected. Focal neurological signs and symptoms developed in all cases following a variable latent period ranging from 4 h to 75 days. CT or MRI at this time revealed areas of cerebral infarction. Diagnosis of carotid injury was made at angiography in all cases. These lesions are treatable if diagnosed prior to the development of extensive infarction. Patients developing focal neurological signs secondary to cerebral infarction after a latent period following head and neck trauma should therefore be considered as having a vascular lesion in the neck and referred for urgent cerebral angiography.
颈部颈动脉钝性损伤，无论是直接暴力还是间接暴力所致，均较为罕见，但可能导致灾难性后果及长期致残。损伤可导致血管壁夹层形成或假性动脉瘤形成。继发性血栓栓塞性疾病会导致脑梗死。在1987年4月至1994年4月的七年期间，2024例头颈部钝性损伤患者入住我院。在该组患者中，8例（0.4%）被确定为颈动脉损伤，7例为夹层形成，1例为假性动脉瘤形成。损伤是由颈部过度伸展或侧方过度屈曲引起的。3例患者颈部无外伤外部体征。所有患者均伴有头部损伤。3例患者出现短暂意识丧失，第4例在受伤后36小时发生短暂性脑缺血发作。这些患者在初次受伤时进行的脑部CT扫描均正常。其余4例患者在初次就诊时无神经功能缺损。在任何情况下均未怀疑有颈动脉损伤。所有病例在4小时至75天不等的可变潜伏期后均出现局灶性神经体征和症状。此时的CT或MRI显示脑梗死区域。所有病例均通过血管造影确诊为颈动脉损伤。如果在广泛梗死发生之前诊断出这些病变，则可进行治疗。因此，头颈部创伤后经过一段潜伏期出现继发于脑梗死的局灶性神经体征的患者，应被视为颈部有血管病变，并应转诊进行紧急脑血管造影。
