Post-traumatic cerebral infarction caused by thrombus in the middle cerebral artery
Post-traumatic cerebral infarction caused by thrombus in the middle cerebral artery
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大脑中动脉血栓引起的外伤后脑梗死
DOI：
10.1016/j.jflm.2022.102474
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发表时间：
2023
影响因子：
1.5
通讯作者：
Kominato Yoshihiko
中科院分区：
文献类型：
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作者：
Hayakawa Akira;Sano Rie;Takahashi Yoichiro;Fukuda Haruki;Okawa Takafumi;Kubo Rieko;Takei Hiroyuki;Komatsu Takakazu;Tokue Hiroyuki;Sawada Yusuke;Oshima Kiyohiro;Horioka Kie;Kominato Yoshihiko
一名80多岁的妇女在过马路时被一辆汽车撞倒，被发现不省人事。入院后，计算机断层扫描（CT）显示创伤性脑损伤（TBI），患者接受了外科治疗。然而，尽管CT图像显示TBI有所改善，但她意外死亡。尸检CT显示右侧大脑中动脉（MCA）区域发生脑梗死。组织学检查显示右侧MCA血栓形成的管腔阻塞和内膜损伤。这些结果表明，在MCA内膜损伤导致血栓形成，血栓栓塞在该地区的远侧损伤导致创伤后脑梗死（PTCI）。验尸CT和尸检都能够揭示死者的最终状况，这是事故发生后治疗她的临床医生没有完全预料到的。多个CT影像及组织病理学检查所显示的从死前到死后的纵向过程，为本病例PTCI的发病机制提供了重要线索。
A woman in her 80s was found unconscious after being hit by a car while crossing a road. After admission to hospitals, computed tomography (CT) scans revealed traumatic brain injury (TBI), and the patient was treated symptomatically. However, despite improvement of TBI in CT images, she died unexpectedly. Postmortem CT demonstrated cerebral infarction in the territory of the right middle cerebral artery (MCA). Histopathological examination revealed lumen-obstructing thrombosis and intimal injury upstream of the thrombosis in the right MCA. These findings suggested that the intimal injury in the MCA had led to thrombus formation, and thromboembolism in the region distal to the injury leading to post-traumatic cerebral infarction (PTCI). Both postmortem CT and autopsy were able to reveal the final condition of the deceased, which had not been fully anticipated by the clinicians who had treated her after the accident. The longitudinal antemortem to postmortem course revealed by multiple CT images and the histopathological examination provided crucial clues to the pathogenesis of PTCI in this case.