Embolic Hippocampal Infarct From Ipsilateral Tandem Carotid Stenosis: A Case Report and Lesson on Hippocampal Dual Vascular Supply.

IF 1.1 4区 医学 Q4 CLINICAL NEUROLOGY
Samantha J Brown, Jennifer Nikolova, Monica Nitu, Justin Cramer, Oana Dumitrascu
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引用次数: 0

Abstract

Introduction: Although primarily supplied by the vertebrobasilar system, the hippocampus is partially supplied by ipsilateral carotid artery branches through the anterior choroidal artery or a prominent posterior communicating artery. We report a patient with acute hippocampus infarction likely due to symptomatic ipsilateral tandem carotid stenosis and discuss acute vascular-mediated hippocampal injury.

Case report: An 80-year-old female with obesity, dyslipidemia, hypertension, alcohol use disorder, history of breast cancer on letrozole, and traumatic brain injury was brought into our emergency department for 24 hours of confusion. On examination, she exhibited limited registration, recall, and executive dysfunction with otherwise normal language, visuo-spatial orientation, and praxis. Brain MRI showed a small area of diffusion restriction in the anterior right hippocampus with matched FLAIR hyperintensity, consistent with acute infarction. Computed tomography angiogram head and neck showed 90% stenosis of the proximal right internal carotid artery (ICA), <50% narrowing of the proximal left ICA, and moderate bilateral narrowing of the paraclinoid ICAs, all due to calcific atheromatous plaques. The etiology of the hippocampal infarction was suspected embolism from the ipsilateral severe carotid stenosis. Planning for right cervical carotid revascularization ensued.

Conclusion: This case highlights the dual hippocampal vascular supply and that hippocampal embolic infarcts could be a sign of a symptomatic severe carotid artery stenosis that may require urgent revascularization for stroke secondary prevention.

同侧串联颈动脉狭窄致栓塞性海马梗死1例及对海马双血管供应的启示。
虽然海马主要由椎基底动脉系统供应,但通过前脉络膜动脉或突出的后交通动脉,同侧颈动脉分支也部分供应海马。我们报告一例急性海马梗死患者,可能是由于症状性同侧串联颈动脉狭窄,并讨论急性血管介导的海马损伤。病例报告:一名80岁女性,肥胖,血脂异常,高血压,酒精使用障碍,来曲唑乳腺癌病史,外伤性脑损伤,24小时就诊于我急诊科。在检查中,她表现出有限的注册、回忆和执行功能障碍,其他方面语言、视觉空间定向和实践正常。脑MRI显示右前海马小区域弥散受限,伴FLAIR高信号,与急性梗死一致。结论:该病例突出了双海马血管供应,海马栓塞性梗死可能是有症状的严重颈动脉狭窄的征兆,可能需要紧急血运重建术以进行卒中二级预防。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurologist
Neurologist 医学-临床神经学
CiteScore
1.90
自引率
0.00%
发文量
151
审稿时长
2 months
期刊介绍: The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.
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