Cerebral Infarction due to Traumatic Internal Carotid Artery Dissection : a Case Report and Review of the Literature

頸動脈剝離極易被忽略，但它卻可能導致腦血管梗塞。本篇報告一位77歲男性病人，因車禍造成頭痛及頸部疼痛，當日急診所做的頭部電腦斷層檢查並無異常，然而在第二天卻出現語言障礙、右眼疼痛、視力模糊及進行性的左側肢體無力。頸部超音波檢查顯示右側內頸動脈血流阻塞，右側內頸動脈近端可見血管內膜瓣及一假腔，此發現和血管剝離現象吻合，其後的磁振造影及磁振血管攝影檢查亦支持此診斷。經過復健治療，病人左側肢體功能進步，以輪椅代步，日常生活需他人部份輔助矢可完成。本例報告提醒臨床醫師外傷性頸動脈剝離是導致腦血管梗塞之少見病因，早期使用非侵襲性頸部超音波及磁振造影和磁振血管攝影檢查，可提供正確之診斷及改善其預後。

關鍵字

頸動脈剝離；腦梗塞；外傷

並列摘要

Traumatic carotid artery dissection is often not recognized at the time of admission, possibly leading to cerebral infarction. This article reports on a 77-year-old man suffering from headache and neck pain after a traffic accident. Although the initial head computed tomography ( CT ) scan revealed no intracranial lesion, progressive left limbs weakness, slurred speech and blurred vision of his right eye developed on the next day after the accident. The color-coded duplex ultrasonography showed an intima flap and a false lumen in his right proximal internal carotid artery ( ICA ), which was compatible with dissection of the vessel. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) confirmed the diagnosis. After rehabilitation training, motor and sensory functions of his left limbs somewhat improved. He became wheel-chair bound and partially depended in activity of daily livings (ADL). This case report reminds the clinicians to carefully consider carotid artery dissection as a cause of stroke, particularly for those with a preceding history of major trauma, headaches or neck pain. If suspected, noninvasive investigations with ultrasound or MRI and MRA should be performed, as prompt intervention may markedly improve prognosis of such patients.

並列關鍵字

carotid artery dissection ； cerebral infarction ； trauma

國際替代計量

Cerebral Infarction due to Traumatic Internal Carotid Artery Dissection : a Case Report and Review of the Literature

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