Arning C, Schrattenholzer A, Lachenmayer L
Department of Neurology, Barmbek Hospital, Hamburg, Germany.
Stroke. 1998 May;29(5):1063-6. doi: 10.1161/01.str.29.5.1063.
The etiology of cerebral ischemic accidents in young adults often remains unclarified.
A 32-year-old woman presented after multiple episodes of left monocular visual impairment and right-sided focal signs. MRI revealed a low-flow infarction on the left; color-coded duplex sonography (CCDS), however, showed normal vascular findings. During the inpatient rehabilitation, a renewed visual impairment occurred; an immediate CCDS examination now demonstrated a filiform stenosis of the left internal carotid artery (ICA) 4 cm above the origin and indirect signs of a severe stenosis of the right ICA. Results of a follow-up examination 18 hours later were again normal. Six weeks later, on reoccurrence of visual impairment, a reversible stenosis of the left ICA was again demonstrated. A search for possible causes of vasospasm was unsuccessful. After treatment with calcium antagonists the patient was free of complaints (with the exception of 3 very short attacks of visual impairment) during the following 12 months.
Cervical carotid artery vasospasms can apparently occur spontaneously without a mechanical trigger. Because their detection is difficult, vasospasms may go undetected.
年轻成年人脑缺血性意外的病因常常仍不明确。
一名32岁女性在多次出现左侧单眼视力障碍和右侧局灶性体征后前来就诊。磁共振成像（MRI）显示左侧存在低灌注梗死；然而，彩色编码双功能超声检查（CCDS）显示血管检查结果正常。在住院康复期间，再次出现视力障碍；此时立即进行的CCDS检查显示，左侧颈内动脉（ICA）在距其起始处4厘米上方存在丝状狭窄，右侧ICA存在严重狭窄的间接征象。18小时后的随访检查结果再次正常。六周后，视力障碍再次出现时，再次显示左侧ICA存在可逆性狭窄。对血管痉挛可能原因的排查未获结果。在使用钙拮抗剂治疗后，患者在接下来的12个月内无不适主诉（仅出现3次非常短暂的视力障碍发作）。
颈内动脉血管痉挛显然可以在无机械性诱因的情况下自发发生。由于其检测困难，血管痉挛可能未被发现。
