Isolated traumatic supraclinoid internal carotid artery dissection diagnosed by high-resolution vessel wall MRI
Isolated traumatic supraclinoid internal carotid artery dissection diagnosed by high-resolution vessel wall MRI
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DOI：
10.1080/02688697.2021.1919861
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发表时间：
2021-09-28
影响因子：
1.1
通讯作者：
Kang, Quanli
中科院分区：
文献类型：
--
作者：
Chen, Shanwen;Ma, Gengping;Kang, Quanli
背景创伤性颈内动脉床突上夹层是钝性颅颌面创伤的罕见并发症，与动脉粥样硬化的鉴别是确诊的关键因素。病例描述一名53岁男子因头部和面部钝伤入院。他的主要表现是第2天左眼外展功能障碍，第4天复发性鼻出血和左耳吹气性杂音。神经系统体格检查显示双侧瞳孔直径正常，右眼矫正视力为0.6，左眼矫正视力为0.3，左眼外展丧失。颅面计算机断层扫描显示多处颅颌面骨折，主要包括左上颌骨LeFort III型损伤、下颌骨左支骨折、左眶尖骨折、蝶鞍骨折等。脑磁共振（MR）结果显示左半球多灶性腔隙性梗死。脑血管造影显示左侧床突上伊卡严重管腔内狭窄，高度怀疑动脉夹层。在第7天进行的高分辨率血管壁MR成像显示近端壁内亚急性出血和损伤区域的两个远端内膜瓣，这两个都有助于排除动脉粥样硬化，从而确认孤立的动脉夹层。患者在两周后接受了血管内支架置入术和抗血小板药物治疗，在接下来的半年时间内没有症状性卒中发作。结论HR vw-MRI对孤立性外伤性床突上夹层合并动脉粥样硬化的诊断具有重要价值。
Background Isolated traumatic supraclinoid internal carotid artery (ICA) dissection is a rare complication of blunt craniomaxillofacial trauma, and differentiation from atherosclerosis is the key factor for confirming the diagnosis. Case description A 53-year-old man was admitted because of blunt trauma to his head and face. His primary manifestations were disability of abduction of the left eye on day 2, recurrent epistaxis and a blowing murmur in the left ear on day 4. Neurological physical examination showed bilateral normal pupil diameter, a corrected visual acuity of 0.6 in the right eye and 0.3 in the left eye, and loss of abduction of the left eye. Craniofacial computed tomography scans revealed multiple craniomaxillofacial fractures mainly including a LeFort III injury of the left maxilla, fractures of the left ramus of the mandible, fractures of the left orbital apex, fractures of the sellar turcica, etc. Brain magnetic resonance (MR) findings showed multifocal lacunar infarcts in the left hemisphere. Cerebral angiography demonstrated severe intraluminal stenosis of the left supraclinoid ICA, which was highly suspicious of arterial dissection. A high-resolution vessel wall MR imaging performed on day 7 showed proximal intramural subacute haemorrhage and two distal intimal flaps at the injured region, both of which facilitated the exclusion of atherosclerosis and thus, confirmation of isolated arterial dissection. The patient underwent treatment with endovascular stent placement and antiplatelet agents two weeks later and had no ictus of symptomatic stroke during the next half-year duration. Conclusions HR vw-MRI is able to assist in the diagnosis of isolated traumatic supraclinoid dissection complicated with underlying atherosclerosis.