Cerebral Infarction following Traumatic Internal Carotid Artery Dissection without Significant Neck Injury: A Case Report

無明顯頸部挫傷之創傷性內頸動脈剝離致腦梗塞：病例報告

陳君山(Kwan-Shan Chan) ； 黃茂雄(Mao-Hsiung Huang) ； 陳嘉炘(Chia-Hsin Chen)

《台灣復健醫學雜誌》 39卷4期 (2011/12) Pp. 233-238

https://doi.org/10.6315/2011.39(4)05

摘要

頸部扭傷造成頸動脈剝離之案例十分罕見，它可能導致遠端血管堵塞，引起腦梗塞及神經功能障礙。本篇報告一位37歲女性病人，因車禍後造成左肩及頸部疼痛，當時意識清醒，送院後發現左側肩膀輕微擦傷，影像學檢查發現左側肱骨頭骨折，其他理學與神經學檢查均無異常。然而在十二小時後，個案意識狀況突然改變，同時出現左側肢體無力之情形，當時腦部電腦斷層影像沒有發現異樣。受傷二十四小時後，個案重度昏迷，磁振造影檢查顯示右中腦動脈區域有訊號增強之病變（high density in diffusion-weighted imaging），磁振血管攝影則顯示右中腦動脈堵塞之情形。頸部超音波檢查發現右內頸動脈血流變慢及粥狀硬化斑（atherosclerotic plaque），並於右內頸動脈近端處出現假腔。經六個月復健後，個案雖然可以持杖行走，但左手肌力仍然不足，部份日常生活需他人協助。本病例報告提醒臨床醫師，造成意外性腦梗塞的原因並非只有頭頸挫傷，過度頸部伸展也能導致頸動脈剝離，特別是個案本身患有頸動脈粥狀硬化。因此早期使用頸部超音波及磁振血管攝影之檢查，可提高正確之診斷率。

關鍵字

頸部挫傷(neck injury) ； 頸動脈剝離(carotid artery dissection) ； 粥狀動脈硬化(atherosclerosis) ； 腦梗塞(cerebral infarction)

並列摘要

A 37-year-old female had an occlusion of right middle cerebral artery (MCA) due to traumatic internal carotid artery (ICA) dissection without significant neck injury after a traffic accident. Although this phenomenon has been documented in recent studies, it remains a relatively rare event. She presented with a left shoulder abrasion injury and mild neck pain initially, although there was no direct head injury or loss of consciousness after the traffic accident. After 12 hours, she had developed confusion, weakness over left limbs and slurred speech. A hyperdense area on the right frontotemporoparietal lobes was found on magnetic resonance imaging (diffusion-weighted imaging). The infarct of the right M1 segment of the MCA was confirmed with magnetic resonance imaging and magnetic resonance angiography. An atherosclerotic plague and dissection in her right ICA were also found after Doppler examination. Craniectomy was performed on the next day after the accident due to the severe brain edema. After six months of rehabilitation, her functional status progressively improved. This case report reminds clinicians that delayed cerebral infarction could occur following an accident of cervical stretching with ICA injury, especially in patients with carotid atherosclerosis, and a Doppler examination of carotid artery is a good screening tool to detect the dissection.

並列關鍵字

neck injury ； carotid artery dissection ； atherosclerosis ； cerebral infarction