Watanabe Y, Mezaki T, Yamamoto Y, Kuzuhara S, Ueyama M
Department of Neurology, Matsusaka Central General Hospital.
Rinsho Shinkeigaku. 1996 May;36(5):670-4.
Two cases of traumatic internal carotid artery occlusion probably related to the seat belt shoulder strap are reported. Case 1. A 20-year-old woman was driving and was struck on the right front side of her car by another car. There were neither bruises, abrasions on her neck, nor weakness in her extremities. About 4 hours later, she developed left hemiplegia, and CT scan taken on the following day revealed low density areas in the capsulostriatal area on the right. The right carotid angiography revealed occlusion of the internal carotid artery about 3 cm distal to the bifurcation. Case 2. A 43-year-old man was driving and was struck on the front of his car by a hard iron railing. He sustained a sternum fracture, but there was no disturbance of consciousness or paresis of the extremities. His neck was unremarkable externally. About 50 days later, he developed left hemiplegia. CT scan and MRI revealed a massive infarction in the distribution of the right middle cerebral artery territories. The carotid angiography revealed occlusion of the right internal carotid artery about 3 cm distal to the bifurcation. In each cases, the driver was wearing a three-point shoulder seatbelt when the car was struck on the front or on the right front. Previous experimental studies have revealed in these situations the neck is flexed right anteriorly, and then quickly overextended left posteriorly. The overextension of the neck probably injured the intima of the internal carotid artery ipsilateral to the shoulder fixed in the seatbelt, resulting in the subsequent occlusion by a thrombus.
报告了两例可能与安全带肩带相关的创伤性颈内动脉闭塞病例。病例1：一名20岁女性驾车时，其汽车右前部被另一辆车撞击。她的颈部既没有瘀伤、擦伤，四肢也没有无力症状。约4小时后，她出现左侧偏瘫，次日进行的CT扫描显示右侧豆状核纹状体区有低密度区。右侧颈动脉血管造影显示颈内动脉在分叉处远端约3 cm处闭塞。病例2：一名43岁男性驾车时，其汽车前部被一根坚硬的铁栏杆撞击。他发生了胸骨骨折，但没有意识障碍或肢体麻痹。其颈部外观无异常。约50天后，他出现左侧偏瘫。CT扫描和MRI显示右侧大脑中动脉供血区有大面积梗死。颈动脉血管造影显示右侧颈内动脉在分叉处远端约3 cm处闭塞。在每例病例中，汽车被前部或右前部撞击时，驾驶员均系着三点式肩部安全带。先前的实验研究表明，在这些情况下，颈部先向右前方屈曲，然后迅速向左后方过度伸展。颈部的过度伸展可能损伤了固定在安全带中的肩部同侧颈内动脉的内膜，随后导致血栓形成并造成闭塞。
