A case of cerebral infarction with dissection of the internal carotid and superior mesenteric arteries.
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A 59-year-old man experienced headache of short duration for several days. Thereafter, he suddenly developed drowsiness, and was admitted to our hospital. He presented with right hemiparesis and left hypoglossal nerve palsy. Cerebral CT and MR scans demonstrated an infarction in the anterior territory of the left middle cerebral artery. Electromyography on the left side of the tongue demonstrated high amplitude polyphasic potentials that suggested peripheral hypoglossal nerve palsy. Cerebral angiography revealed an irregular stenosis of the left internal carotid artery at the skull base. An axial MR scan at the same level demonstrated a flow void signal surrounded and constricted by a crescentic high-intensity area on both T<SUB>1</SUB>- and T<SUB>2</SUB>-weighted images. These findings were compatible with the radiologic features of subacute internal carotid artery dissection. The various radiologic abnormalities disappeared within 3 months. Studies of the systemic vascular system disclosed an irregular right renal artery, and dissection of the superior mesenteric artery. The cerebral infarction could be a result of ischemia, and the hypoglossal palsy could be a result of direct nerve compression by the dissected internal carotid artery. The arterial dissection at several separate locations may indicate intrinsic wall weakness of the systemic arteries. Although we did not obtain typical arteriographic findings suggestive of fibromuscular dysplasia, we conclude that fibromuscular dysplasia was a possible cause of the artreial dissection in the present patient, since both the internal carotid and superior mesenteric arteries are most likely to be involved in fibromuscular dysplasia.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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