抄録
A 47-year-old man was admitted to our hospital because of left upper extremity paralysis sustained during a combative sport. He complained of neck discomfort but was alert, and his NIHSS was 2/42. There was no early CT stroke sign on CT. An MRI diffusion image revealed no early cerebral infarction. Carotid ultrasonography demonstrated no stenosis from the right common carotid to the right internal carotid artery (ICA). The left / right common carotid artery (CCA) end－diastolic velocity ratio was increased to 2.6, and the pulsatility index (PI) of the right CCA was 4.18. These findings suggested stenosis or obstruction of the right ICA. Cervical MRA demonstrated a pearl and string sign in the right ICA. Therefore, the patient was diagnosed as having traumatic right ICA dissection. We ligated the right ICA and reconstructed it employing a high－flow bypass 3 weeks after admission because of a dissecting aneurysm of the ICA and miserly perfusion of the watershed region in the right cerebral hemisphere. This case emphasizes the usefulness of cervical ultrasound examination with pulse Doppler for diagnosis of an ICA stenotic lesion including dissection.
