Cavernous sinus syndrome and headache due to bilateral carotid artery aneurysms.
Cavernous sinus syndrome and headache due to bilateral carotid artery aneurysms.
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DOI：
10.1001/archneur.60.9.1327
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发表时间：
2003-09
影响因子：
--
通讯作者：
A. Atri;V. Sheen
中科院分区：
文献类型：
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作者：
A. Atri;V. Sheen
一名有高血压和佩吉特病病史的N 8 9 Y E A R O L D女性出现严重的搏动性右侧头痛。两年前，一次跌倒导致她的手臂骨折，几周后，她开始出现右眼疼痛和肿胀，随后右前额麻木和“视力模糊”。在最近的神经系统检查中（图1A），她有明显的右侧上睑下垂、右侧内斜视和完全性眼肌麻痹。右侧瞳孔固定并扩大（图1B）。三叉神经的右眼（V1）和上颌（V2）分支的感觉在所有模式中均减弱。头部计算机断层扫描（图2）显示海绵窦右侧病变大于左侧。轴向T1加权磁共振成像（图3A）和磁共振血管造影（图3B和C）显示双侧海绵窦颈动脉瘤含有血栓，可能导致右侧海绵窦中颅神经III、IV、V1、V2和VI的压迫和功能障碍。尝试对右侧动脉瘤进行血管内闭塞未成功，手术被拒绝。她的搏动性头痛局限于右太阳穴和上面部，推测是由搏动性动脉瘤和三叉神经撞击引起的。加巴喷丁治疗后头痛消退。
A N 8 9 Y E A R O L D woman with a history of hypertension and Paget disease had a severe throbbing right-sided headache. Two years previously, a fall had resulted in the fracture of her arm, and weeks later, she began to develop pain and swelling in the right eye, followed by numbness of the right forehead and “blurred vision.” On a recent neurologic examination (Figure 1A), she had marked right ptosis, right esotropia, and complete ophthalmoplegia. The right pupil was fixed and dilated (Figure 1B). Sensation was diminished in all modalities in the right ophthalmic (V1) and maxillary (V2) divisions of the trigeminal nerve. Computed tomography of the head (Figure 2) revealed lesions that were larger on the right than on the left side in the cavernous sinuses. Axial T1-weighted magnetic resonance imaging (Figure 3A) and magnetic resonance angiography (Figure 3B and C) demonstrated bilateral cavernous carotid aneurysms containing thrombi, presumably causing compression and dysfunction of cranial nerves III, IV, V1, V2, and VI in the right cavernous sinus. Attempts at endovascular occlusion of the aneurysm on the right side were unsuccessful, and surgery was declined. Her throbbing headaches were localized to the right temple and upper face and were presumably caused by the pulsating aneurysm and impingement on the trigeminal nerves. Her headache resolved following treatment with gabapentin.