Pseudo-occlusion of the extracranial carotid artery caused by intracranial carotid artery stenosis.

摘要

A 70-year-old female with hypertension and diabetes presented to the emergency room with sudden-onset drowsy mentation and disorientation. Her blood pressure was 130/80 mmHg, pulse rate was 70%>eats per minute, respiratory rate was 18 breaths per minute, and body temperature was 36.7°C. Neurologic examination indicated confusion and generalized myoclonic jerks. Blood chemistry tests revealed an elevation of blood urea nitrogen and creatinine (83 and 3.5 mg/dl, respectively). Small deep infarcts on the right basal ganglia and corona radiata were visible on brain MRI (Fig. la), but a high signal intensity was not evident on the diffusion weighted image. In addition, her right proximal internal carotid artery (ICA) was invisible on contrast-enhanced magnetic resonance angiography (CE-MRA) (Fig. lb). MRI was performed with a Signa Excite XI Twin Speed 1.5T system (GE Healthcare, Milwaukee, WI, USA).