窒息后静息性双侧颈内动脉夹层

Bryan Dalton, Mark Coyle, Paul Tansey, Clare Fallon, Vivek Raman, U. Healy
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引用次数: 0

摘要

双侧颈内动脉夹层并不常见,而上吊自杀可能是直接血管损伤的潜在机制。以前的报道已经记录了类似的事件,意识是重要的,因为颈内动脉夹层是一个广泛认可的急性脑血管事件的原因。我们的病例是一个病人表现出急性中风的症状。值得注意的是,在入院前4年有过上吊自杀未遂的病史。影像学显示双侧颈内动脉夹层,急性缺血性梗死和偶然建立梗死。进一步的调查以评估双侧颈内动脉夹层的潜在病因,但未能确定次要原因。上吊自杀未遂后发生外伤性颈内动脉夹层相关的急性颅内发作已有文献记载。然而,这类报道往往与创伤期有关,患者在上吊未遂后的短时间内出现神经系统症状。我们假设潜在血管损伤的延迟表现是由先前的上吊企图引起的刺激性颈部创伤引起的。内颈动脉剥离和血管扭曲继发于企图上吊的可能性提示这是一个高危人群,考虑对这一群体进行选择性血管成像调查可能有助于预防急性卒中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Quiescent Bilateral Internal Carotid Artery Dissection Following Strangulation
Bilateral internal carotid artery dissection is uncommon and suicide attempts by hanging represent a potential mechanism of direct vascular trauma. Previous reports have documented similar events and awareness is important as internal carotid artery dissection is an extensively recognized cause of acute cerebrovascular events. Our case is of a patient presenting with symptoms suggestive of an acute stroke. Significantly, there was a past medical history of an attempted suicide by hanging 4 years before this admission. Imaging demonstrated bilateral internal carotid artery dissection, an acute ischemic infarct and an incidental well-established infarct. Further investigations to assess an underlying aetiology of the bilateral internal carotid artery dissection were unsuccessful in identifying a secondary cause. Acute intracranial episodes related to traumatic internal carotid artery dissection following suicide attempts by hanging have previously been documented. However, such reports have frequently been temporally related to the period of trauma with patients developing neurological symptoms within a short timeframe after the hanging attempt. We hypothesize a delayed manifestation of underlying vascular damage caused by the inciting neck trauma by prior hanging attempt. The potential for internal carotid artery dissection and vascular distortion secondary to attempted hanging are suggestive of a high-risk cohort, and consideration of selective vascular imaging investigations of this group may be useful in acute stroke prevention.
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