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一侧颈内动脉或椎动脉自发性夹层动脉瘤,几年前是较少见的,而双侧颈内动脉或椎动脉夹层动脉瘤尤为罕见。本文报告至少三条大的动脉自发性急性夹层动脉瘤二例。例一:女40岁,服避孕丸6年,两周来出现急性头痛、颈痛与呕吐,左耳可听到杂音,入院次日头痛及杂音逐渐加重。症状发生10天后有短暂的意识丧失,4天后突发视力模糊,持续15分钟,继后视力下降。血压190/120mmHg。查体:除有Horner氏征及左侧头颈部可听到粗大的杂音外,神经系无其它异常。脑CT正常,未用强化对比剂。全脑血管造影:右侧颈内动脉起始部广泛严重的狭窄,并延及虹吸部及经眼动脉逆行至颈外动脉。左侧末梢血管明显狭窄,在C_1水平示扩张的动脉瘤。左侧椎动脉从起始至末梢血管不规则狭窄扩延至C_3水平,并发现二个扩张动脉瘤。右侧椎动脉除发育不良外,在C_1段显示严重的狭窄。左侧椎动脉被双侧大脑中动脉所充盈。经用大剂量肝素治疗2周后,血管杂音和头痛消失,但左侧Horner氏征无变化,8月后造影示完全建立侧支循环,多普勒超声检查正常。例二:女,42岁,亦有服避孕丸史10
One side of the internal carotid artery or vertebral artery dissecting aneurysms, a few years ago is rare, and bilateral internal carotid artery or vertebral artery dissection aneurysm is particularly rare. This article reports at least three large arterial spontaneous acute dissection aneurysms in two cases. Example 1: Female 40 years old, taking contraceptive pills 6 years, two weeks of acute headache, neck pain and vomiting, left ear can be heard murmur, admission, headache and murmur gradually increased the next day. Short-term loss of consciousness ten days after symptom onset, sudden onset of visual acuity 4 days later, lasting 15 minutes, followed by decreased visual acuity. Blood pressure 190 / 120mmHg. Physical examination: In addition to Horner’s sign and the left head and neck can hear coarse noise, the nervous system no other abnormalities. Brain CT normal, not with enhanced contrast agent. Cerebral angiography: the right side of the beginning of extensive internal carotid stenosis, and extension of the siphon and ophthalmic artery retrograde to the external carotid artery. The left peripheral vessels were significantly stenosed, showing an aneurysm at dilation of C_1. Left vertebral artery from the initial to peripheral vascular stenosis extended to C_3 level and found two dilatation aneurysms. In addition to the right side of the vertebral artery dysplasia, in the C 1 segment showed severe stenosis. The left vertebral artery is filled with bilateral middle cerebral arteries. After 2 weeks of treatment with high-dose heparin, the vocal cords and headache disappeared, but there was no change in the Horner’s sign on the left. After August, angiography showed that collateral circulation was completely established and Doppler ultrasound was normal. Case two: female, 42 years old, also have a history of contraceptive pills 10