Yamaguchi S, Oki S, Ogasawara H, Sato H, Ito Y, Hibino S
Department of Neurosurgery, Hiroshima City Asa Hospital, Japan.
No Shinkei Geka. 1997 Mar;25(3):247-51.
Cases of bilateral cartoid occlusion have often been reported in the literature, but most of them were not examples of simultaneous bilateral carotid occlusion. Simultaneous bilateral cartoid occlusion appears to be rare, so we report one such case in this paper. A 68-year-old woman suddenly became unconscious, and was delivered to our hospital by ambulance. On arrival, she was comatose and showed decerebrate rigidity upon pain stimulation. Results of CT scan were normal, but cerebral angiography showed bilateral internal carotid artery occlusion at the carotid bifurcation. The patient was treated with urokinase and osmotic diuretics, but these were not effective and she died on the eleventh day after admission. Autopsy revealed that the bilateral internal carotid artery was occluded by fresh thrombi at the carotid bifurcation. The mitral valve was thickened by fibrous adhesion, and this was thought to indicate mitral stenosis. MRI before onset had shown flow void sign in the bilateral internal carotid artery. From the clinical course, and radiological and autopsy findings, we consider this case to be one of simultaneous bilateral carotid occlusion due to cardiogenic thrombi. Previous cases of bilateral carotid occlusion are reviewed and discussed.
双侧颈动脉闭塞的病例在文献中常有报道，但其中大多数并非双侧颈动脉同时闭塞的例子。双侧颈动脉同时闭塞似乎较为罕见，因此我们在本文中报告这样一例病例。一名68岁女性突然昏迷，由救护车送至我院。入院时，她处于昏迷状态，疼痛刺激时表现出去大脑强直。CT扫描结果正常，但脑血管造影显示双侧颈内动脉在颈动脉分叉处闭塞。患者接受了尿激酶和渗透性利尿剂治疗，但这些治疗无效，她在入院后第11天死亡。尸检显示双侧颈内动脉在颈动脉分叉处被新鲜血栓阻塞。二尖瓣因纤维粘连而增厚，这被认为提示二尖瓣狭窄。发病前的MRI显示双侧颈内动脉有血流空信号。根据临床病程、影像学和尸检结果，我们认为该病例是一例由心源性血栓导致的双侧颈动脉同时闭塞。对既往双侧颈动脉闭塞的病例进行了回顾和讨论。
