背景:意识障碍是短暂性脑缺血发作(TIA)的非局灶性症状,在椎基底动脉狭窄或闭塞患者中经常观察到。相反,由于前循环受累导致的意识丧失(例如,大脑中动脉[MCA])在TIA中很少发生。
方法:本报告描述了一名59岁女性的罕见病例,该女性因MCA闭塞或狭窄而反复发作意识改变。
方法:病例的诊断从TIA更新为急性脑梗死,finally.在最初的意识丧失之后,头颅磁共振成像(MRI)未发现任何急性脑梗死的证据.然而,在第二和第三集无意识之后,MRI显示多发新的急性脑梗死影响两个大脑半球。通过数字减影血管造影进行的进一步评估显示,左侧MCA完全闭塞,右侧MCA严重狭窄。
方法:在她生病的早期,患者接受了血管扩张剂治疗,阿司匹林和阿托伐他汀。最后,分别在她的右侧和左侧MCA中放置2个支架,然后用阿司匹林治疗,氯吡格雷,和双剂量阿托伐他汀钙。同时,患者专注于避免在日常生活中可能导致脱水的情况。
结果:该患者的意识障碍发作已完全解决。术后1年随访期间,患者保持临床稳定,没有任何意识障碍的症状,肢体麻木或无力,或者头晕.
结论:这些研究结果表明,双侧大脑半球的灌注不足在促使患者意识障碍发作中起关键作用。这种情况强调了两种MCA中的闭塞或严重狭窄可能会导致由于灌注不足而反复发作的意识障碍的可能性。此外,它强调了这些无意识发作与随后缺血性卒中风险增加之间的关联.
BACKGROUND: Unconsciousness is a nonfocal symptom of transient ischemic attack (TIA) that is frequently observed in patients with vertebrobasilar artery stenosis or occlusion. Conversely, loss of consciousness due to anterior circulation involvement (e.g., middle cerebral artery [MCA]) is a rare occurrence in TIA.
METHODS: This report describes a rare
case in a 59-year-old woman who experienced recurrent episodes of altered consciousness because of the occlusion or stenosis of her MCAs.
METHODS: The diagnosis of the
case was updated from TIA to acute cerebral infarction, finally. Following initial loss of consciousness, cranial magnetic resonance imaging (MRI) did not reveal any evidence of acute cerebral infarction. However, following the second and third episodes of unconsciousness, the MRI revealed multiple new acute cerebral infarcts affecting both the cerebral hemispheres. Further evaluation through digital subtraction angiography disclosed complete occlusion of the left MCA and severe stenosis of the right MCA.
METHODS: Early in her illness, the patient was treated with vasodilators, aspirin and atorvastatin. Finally, 2 stents in her right and left MCAs were placed respectively, followed by treatment with aspirin, clopidogrel, and double-dosed atorvastatin calcium. Meanwhile, the patient focused on avoiding conditions which may lead to dehydration in her daily life routine.
RESULTS: The episodes of unconsciousness of this patient were completely resolved. During the 1-year postoperative follow-up, the patient remained clinically stable without any symptoms of unconsciousness, limb numbness or weakness, or dizziness.
CONCLUSIONS: These findings suggested that hypoperfusion in the bilateral cerebral hemispheres played a pivotal role in precipitating the patient episodes of unconsciousness. This
case underscores the possibility that occlusion or severe stenosis in both MCAs can contribute to recurrent episodes of unconsciousness due to hypoperfusion. Moreover, it emphasizes the association between these episodes of unconsciousness and an increased risk of subsequent ischemic stroke.