抄録
A 44-year-old man was hospitalized for sudden onset of left hemiplegia. Cerebral angiograms revealed a web-like stenosis at the origin of the bilateral internal carotid artery and occlusion of the right middle cerebral artery. By arterial injection of urokinase and hemodilution therapy, the symptom disappeared at 5 hours after onset. A CT scan on the 2nd day showed an infarction of the right temporo-parietal lobe. Blood data including the coagulation-fibrinolysis system, electorocardiogram and echocardiogram showed no abnormal findings. Based on the belief that the web-like stenosis in the right internal carotid artery is the source of thromboembolism, the right carotid endarterectomy was performed. The resected specimen was diagnosed as intimal fibroplasia histopathologically.
As the clinical characteristics of 8 cases with web-like stenosis at the origin of the internal carotid artery including the present case, the disease develops in young adults and focal ischemic symtoms are recognized in all cases. Histopathologically, the proportion of intimal fibroplasia is high with 6 cases, and patients with recurrent symptoms while being medically treated may require surgery.
