症例報告
頭蓋内椎骨動脈逆流の経時的変化を超音波で評価しえた椎骨動脈解離の1例
2016 年 29 巻 2 号 p. 108-111
詳細
2016 年 29 巻 2 号 p. 108-111
A 54-year-old man with untreated hypertension presented to our emergency room with dizziness and vomiting. Neurological findings were essentially normal, so the peripheral vertigo was treated with sodium bicarbonate. However, symptoms persisted 6 h later, so magnetic resonance imaging (MRI) was performed. Blood pressure was 149/90mmHg, electrocardiography showed sinus rhythm, and no specific changes in the blood were evident. Nystagmus was the only neurological sign, but MRI revealed acute ischemic lesions in the territory of the right posterior inferior cerebellar artery. Visualization of the right vertebral artery (VA) was poor on MR angiography. Carotid duplex ultrasonography showed to and fro movement of the right VA, and transcranial color flow imaging revealed reversed and flattened flow in the right intracranial VA. Three sequential ultrasonographic assessments showed gradual increases in intracranial reversed VA flow (RVAF), with concomitant decreases in extracranial VA flow. The angiographic findings of stenosis and dilation in the right-origin VA indicated a diagnosis of VA dissection. Intracranial RVAF is quite frequently associated with VA dissection. Ultrasonographic follow-up to detect changes in intracranial RVAF is useful for evaluating the hemodynamic status of patients with acute VA dissection.
