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Neurology:颈动脉蹼的病理和血栓栓塞

2020-04-26 zyx 神经科病例撷英拾粹

43岁女性,既往史无殊,出现急性大脑中动脉(MCA)闭塞。

43岁女性,既往史无殊,出现急性大脑中动脉(MCA)闭塞(图1A)。检查排除了其他血栓形成倾向病因和血管炎,超声心动图正常。检查发现源自左侧颈动脉球部的搁板状突起(图1C),考虑颈动脉蹼,怀疑是MCA栓塞的原因。行颈动脉内膜切除术。隔板状结构镜下可见富含平滑肌细胞的内膜,弹性组织增加和粘液样变性(图2A-B)。在蹼兜(web pocket)中发现了叠加血栓形成(图2C)。术后CT血管造影提示左侧MCA自发再通(图1B)。


(图1:A-B:左侧大脑中动脉远端M1段闭塞并完全自发再通;C:源自左侧颈动脉球部后壁的搁板状突起[箭])


(图2:A:高倍镜下HE染色可见富含平滑肌细胞的内膜伴粘液样变性;B:大体标本可见位于颈内动脉后外侧壁的蹼,表面平滑[箭],在蹼兜上有叠加血栓形成[箭头];C:弹力纤维染色可见蹼兜中弹性组织增生和血栓[箭])

原始出处:Ma Y, Yang B, Jiao L. Teaching NeuroImages: Pathology and thromboembolism of carotid web.Neurology. 2020 Feb 18;94(7):e762-e763.

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    2020-08-29 yinhl1978
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    2020-04-26 qjzhai1623

    有用的病例

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