颈动脉夹层抗凝vs抗血小板摘要.ppt

* 47岁男性患者，钓鱼过程中突发眩晕，立即送医院，当时查体仅仅存在眼球震颤 立即CT无异常 发病后24小时突然头痛恶心呕吐 复查CT提示双侧小脑半球梗死 18小时后突发意识丧失，复查CT提示SAH DSA过程中死亡 * Transcranial Doppler in the Evaluation of Internal Carotid Artery Dissection Jayashree Srinivasan, MD; David W. Newell, MD; Matthias Sturzenegger, MD; Marc R. Mayberg, MD; H.R. Winn, MD the Department of Neurological Surgery, University of Washington School of Medicine, Seattle; and the Department of Neurology, University of Bern (Switzerland) (M.S.). Correspondence to David W. Newell, MD, Department of Neurological Surgery, University of Washington School of Medicine, Box 359766, Seattle, WA 98104. ?? Abstract TopAbstractIntroductionSubjects and MethodsIllustrative CasesResultsDiscussionReferences?Background and Purpose A subject with dissection of the internal carotid artery (ICA) may present with a variety of symptoms, from headache to stroke. Thus far, it has not been possible to identify the subset of patients at risk for cerebral ischemia. Because the majority of these ischemic events are secondary to embolic phenomena, we used transcranial Doppler (TCD) evaluation with emboli monitoring to study 17 consecutive patients with ICA dissection treated at Harborview Medical Center, Seattle, Wash, during a 2-year period from 1992 until 1994. Methods Ten patients with ICA dissection secondary to trauma and seven with spontaneous ICA dissection were diagnosed by carotid angiography and studied by TCD from the time of diagnosis through initiation of therapy. Emboli monitoring was performed in the middle cerebral artery (MCA) ipsilateral to the dissection at the initial evaluation and intermittently thereafter to ensure that the emboli stopped with treatment. Results Emboli were detected in the MCA distal to the dissection in 10 of 17 patients (59%). Patients with microemboli detected by TCD presented with a stroke (70%) much more frequently than those without emboli (14%) (P=.0498). The presence of a pseudoaneurysm did not increase the risk of