Dilated Episcleral Arteries — a Significant Physical Finding in Assessment of Patients with Cerebrovascular Insufficiency Cerebrovascular Disease in Sickle Cell Anemia: a Clinical, Pathological and Radiological Correlation
Dilated Episcleral Arteries — a Significant Physical Finding in Assessment of Patients with Cerebrovascular Insufficiency Cerebrovascular Disease in Sickle Cell Anemia: a Clinical, Pathological and Radiological Correlation
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巩膜外动脉扩张——评估脑血管功能不全患者镰状细胞性贫血脑血管疾病的重要物理发现：临床、病理和放射学相关性
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通讯作者：
Donovan Post
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作者：
R. Countee;A. Gnanadev;Pamela Chavis;E. T. Caseii;Kurt H H Merkel;Paul L Ginsberg;Joseph C Parker;M. Judith;Donovan Post
摘要虽然没有得到广泛的重视，但以前已经报道了与同侧颈内动脉闭塞相关的巩膜上血管扩张。这些眼部变化被认为是眼部缺血的表现。作者最近在7名患者中发现了这种迹象，没有一名患者存在眼部缺血的证据。除了同侧颈内动脉闭塞外，动脉造影显示，同侧大脑半球的主要血液供应来源是通过从眼眶中扩张的颈外动脉侧支通道以逆行方式填充的显著增大的眼动脉的逆行流动。巩膜上动脉扩张是眼眶血流量增加的标志，也是同侧大脑半球侧支供血的主要来源，这一点以前未见报道。我们再次强调对怀疑有颈内动脉闭塞的患者仔细检查巩膜外血管的重要性。脑血管闭塞性疾病患者的眼部体征多种多样。其中，与同侧颈动脉闭塞相关的巩膜外血管扩张，可能是眼部缺血的一个迹象，以前已有报道。1'2然而，这种联系并没有得到广泛的重视。作者最近遇到了7例颈内动脉闭塞与同侧巩膜上动脉扩张的6例患者，其中没有眼部缺血的迹象。此外，然而，血管造影显示，受影响半球的主要血液来源是通过显着扩张的眼动脉从颈外动脉眶侧支通道逆行充盈。我们认为，这种眼部体征可能意味着眼眶血流量增加，因此，对临床医生来说，它具有额外的生理意义，因为它强调了保持颈外动脉通畅的重要性。两个代表性的案例进行了说明。入院前三个月，他有几次短暂的左侧虚弱的病史。这些发作经常伴有短暂的头晕感觉，有一次，据报告，完全失去意识持续了24小时。据说这次的左侧无力持续了大约48小时。然而，随后的袭击持续时间不超过“几分钟”至2至3小时。该患者是已知的高血压患者，曾因血压不受控制而入院两次。入院后，他被发现一般健康，但aesthenic ...
SUMMARY Dilated episcleral vessels associated with ipsilateral internal carotid artery occlusions have been previously reported though not widely appreciated. These ocular changes have been presumed to be manifestations of ocular ischemia. The authors have recently encountered this sign in seven patients and in none was there evidence of ocular ischemia. In addition to an ipsilateral internal carotid artery occlusion, arteriograms demonstrated that the major source of blood supply to the homolateral cerebral hemisphere was by retrograde flow through markedly enlarged ophthalmic arteries filled in retrograde fashion from dilated external carotid collateral channels in the orbit. This association of dilated episcleral arteries as a sign of increased orbital blood flow and the major source of collateral blood supply to the homolateral cerebral hemisphere has not been previously reported. We reemphasize the importance of a careful examination of the episcleral vessels in patients suspected of having internal carotid artery occlusions. A GREAT VARIETY of ocular signs have been described in patients with cerebrovascular occlusive disease. Among these, dilated episcleral vessels associated with ipsilateral carotid artery occlusion, presumably a sign of ocular ischemia, have been previously reported. 1 ' 2 This association , however, has not been widely appreciated. The authors have recently encountered seven instances of internal carotid artery occlusion associated with ipsilateral dilated episcleral arteries in six patients in whom no signs of ocular ischemia were present. In addition, however, angiograms revealed that the major source of blood to the affected hemispheres was by way of markedly dilated ophthalmic arteries filling retrograde from external carotid orbital collateral channels. This ocular sign, we believe, may imply increased orbital blood flow and, therefore, carries additional physiological significance for the clinician in that it emphasizes the importance of maintaining a patent external carotid artery. Two representative cases are described. with a history of several episodes of transient weakness of his left side for three months prior to his admission. Frequently the episodes were accompanied by fleeting sensations of giddiness and on one occasion with a complete loss of consciousness reported to have lasted 24 hours. The left-sided weakness on this occasion is said to have lasted about 48 hours. However, the subsequent attacks lasted no more than a "few minutes" to 2 to 3 hours. The patient was a known hypertensive who had had two previous admissions for uncontrolled blood pressure elevations. Upon hospital admission he was found to be generally healthy but aesthenic …