Neurosonology:神経超音波医学
Print ISSN : 0917-074X
ISSN-L : 0917-074X
症例報告
t-PA静注療法中に頚部血管超音波検査で内頚動脈閉塞の再開通現象を観察しえた脳梗塞の1例
坂井 健一郎井口 保之兼子 宜之青木 淳哉山下 眞史渡邉 雅男岩永 健松本 典子芝崎 謙作木村 和美
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2009 年 22 巻 2-3 号 p. 83-86

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We report an 81-year-old man who suddenly felt weakness of the right upper and lower extremities. He was admitted to our hospital within 1 hour after onset Neurological examination revealed consciousness disturbance and right hemiparesis. The National Institutes of Health Stroke Scale (hflHSS) score in the emergency room was 7. As the neurological impairment was completely resolved in the emergency room, we diagnosed the patient as having a transient ischemic attack. However, 5 hours after admission, aphasia and right hemiparesis recurred with a NIHSS score of 5, and MR angiography demonstrated occlusion of the left internal carotid artery (ICA) corresponding to hyper-intense lesions in the left frontal lobe on diffiasion-weighted imaging. We treated the patient with intravenous tissue plasminogen activator (IV t-PA) while monitoring the left ICA using carotid ultrasonography. Initially, the blood flow velocity in the left ICA showed an occluded pattern, and then 30 minutes after starting IV t-PA, the left ICA demonstrated diastolic flow velocity. After several minutes, the flow pattern in the left ICA changed to a normal one. The neurological manifestations showed dramatic improvement, with a NfflSS score of 1. Carotid duplex ultrasonography appears to be a promising tool for observation of recanalization after ICA occlusion.

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© 日本脳神経超音波学会 2009
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