METHODS: We present the case of an 85-year old male with perioperative haemodynamic stroke during carotid endarterectomy. Ischemic stroke was caused by suddenly increased carotid stenosis resulting in major neurologic deficit. This was registered only by transcranial doppler, while surface electroencephalography and near-infrared spectroscopy failed to detect any significant change in cerebral perfusion, despite a large perfusion defect on computed tomography. Circulation was restored with endovascular treatment and neurologic deficit quickly resolved.
CONCLUSIONS: We strongly advocate the practice of multimodal neuromonitoring including transcranial doppler whenever possible to minimize the risk of persistent neurologic deficit due to perioperative stroke during carotid endarterectomy.
方法:我们介绍了一例85岁男性在颈动脉内膜切除术中出现围手术期血流动力学卒中的病例。缺血性中风是由突然增加的颈动脉狭窄引起的,导致严重的神经功能缺损。这只通过经颅多普勒记录,而表面脑电图和近红外光谱未能检测到脑灌注的任何显著变化,尽管计算机断层扫描有很大的灌注缺陷。血管内治疗可恢复循环,神经功能缺损迅速解决。
结论:我们极力主张采用多模式神经监测,包括经颅多普勒,以尽可能降低颈动脉内膜切除术期间由于围手术期中风引起的持续性神经功能缺损的风险。