Bithalamic Infarction (Artery of Percheron Occlusion) after Anterior Cervical Discectomy and Fusion
Bithalamic Infarction (Artery of Percheron Occlusion) after Anterior Cervical Discectomy and Fusion
复制标题
DOI：
10.1155/2019/9438089
复制
发表时间：
2019-01-01
影响因子：
0.9
通讯作者：
Elsharkawy, Alaa Eldin
中科院分区：
文献类型：
--
作者：
Afana, Hatem B.;Abuhadrous, Nidal M. M.;Elsharkawy, Alaa Eldin
颈椎手术后 Percheron 动脉闭塞引起的双丘脑梗死是一种罕见的病理实体。诊断和早期检测具有挑战性。及时管理可能有助于改善结果。我们介绍了一名 39 岁男性患者，吸烟者，被诊断患有多发性颈椎间盘突出症，接受了 C3-C4、C4-C5 和 C5-C6 的前路颈椎间盘切除融合术 (ACDF)。在2小时50分钟的手术过程中，患者仰卧，颈部过度伸展。术中过程很顺利。手术过程中，血压在110mmHg\50mmHg左右。手术结束时，患者全身麻醉苏醒正常，无延误或并发症；第二天，患者突然失去知觉。紧急脑部计算机断层扫描（CT）正常；两天后，随访CT和CT血管造影（CTA）显示双侧丘脑梗塞，右侧椎动脉从其起源处闭塞。术中手术操作、低血压麻醉和颈部长时间过度伸展可能导致该患者发生中风。 ACDF 具有后循环卒中的潜在风险。 ACDF 后突然意识丧失的患者的鉴别诊断应考虑 Percheron 动脉梗塞。椎动脉血栓形成应被视为栓塞的一个重要可能原因。
Bithalamic infarction resulting from occlusion of the artery of Percheron after cervical spine surgery is a rare pathological entity. Diagnosis and early detection are challenging. Prompt management may help to improve the outcome. We present a case of a 39-year-old male patient, smoker, diagnosed with multiple cervical disc herniations, who underwent Anterior Cervical Discectomy and Fusion (ACDF) for C3-C4, C4-C5, and C5-C6. During the 2-hour and 50-minute surgery, the patient was lying supine with his neck hyperextended. The intraoperative procedure was uneventful. During surgery, blood pressure ranged around 110 mmHg\50 mmHg. At the end of surgery, the patient's recovery from general anesthesia was normal with no delaying or complication; on next the day, patient developed a sudden loss of consciousness. Urgent brain computed tomography (CT) was normal; two days later, follow-up CT and CT Angiography (CTA) revealed bilateral thalamic infarction with right vertebral artery occlusion from its origin. Intraoperative surgical manipulation, hypotensive anesthesia, and prolonged neck hyperextension might have contributed to stroke in this patient. ACDF carries a potential risk for posterior circulation stroke. Artery of Percheron infarction should be considered in the differential diagnosis of patients developing a sudden loss of consciousness after ACDF. Vertebral artery thrombosis should be taken into account as an important possible cause of embolism.