Zusammenfassung
Traumatische Dissektionen der Arteria carotis interna sind eine wichtige Differenzialdiagnose
bei neuroophthalmologischen Symptomen, die nach Traumata gegen Kopf oder Hals auftreten.
Wir berichten über einen 52-jährigen Mann, der wenige Stunden nach einem stumpfen
Halstrauma eine unilaterale Amaurose und Ophthalmoplegie ohne Pupillenbeteiligung
entwickelte. MRT und Dopplersonografie zeigten eine Dissektion der rechten A. carotis
interna. Unter Antikoagulation war die Motilitätsstörung teilweise rückläufig, während
der Visus dauerhaft erloschen blieb.
Abstract
Traumatic dissection of the internal carotid artery is an important differential diagnosis
in patients presenting with neuro-ophthalmological symptoms after sustaining head
or neck trauma. We present the case of a 52-year-old man who developed unilateral
amaurosis and pupil-sparing ophthalmoplegia shortly after a blunt neck trauma. MR
imaging and duplex sonography revealed dissection of the right internal carotid artery.
Under anticoagulant treatment, motility of the eye improved, while blindness remained
permanent.
Schlüsselwörter
Arteria-carotis-interna-Dissektion - Amaurosis - Ophthalmoplegie
Keywords
internal carotid artery dissection - amaurosis - ophthalmoplegia
Literatur
- 1
Mokri B, Piepgras D G, Houser O W.
Traumatic dissections of the extracranial internal carotid artery.
J Neurosurg.
1988;
68
189-197
- 2
Mokri B.
Traumatic and spontaneous extracranial internal carotid artery dissections.
J Neurol.
1990;
237
356-361
- 3
Vargas M E, Desrouleaux J R, Kupersmith M J.
Ophthalmoplegia as a presenting manifestation of internal carotid artery dissection.
J Clin Neuroophthalmol.
1992;
12
268-271
- 4
Biousse V, Touboul P J, D’Anglejan-Chatillon J et al.
Ophthalmologic manifestations of internal carotid artery dissection.
Am J Ophthalmol.
1998;
126
565-577
- 5
Guillon B, Lévy C, Bousser M G.
Internal carotid artery dissection: an update.
J Neurol Sci.
1998;
153
146-158
- 6
Newman N J, Kline L B, Leifer D et al.
Ocular stroke and carotid artery dissection.
Neurology.
1989;
39
1462-1464
- 7
Biousse V, Schaison M, Touboul P J et al.
Ischemic optic neuropathy associated with internal carotid artery dissection.
Arch Neurol.
1998;
55
715-719
- 8
Klijn C J, Kappelle L J, Tulleken C A et al.
Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors.
Stroke.
1997;
28
2084-2093
- 9
Costa V P, Kuzniec S, Molnar L J et al.
Collateral blood supply through the ophthalmic artery: a steal phenomenon analyzed
by color Doppler imaging.
Ophthalmology.
1998;
105
689-693
- 10
Lapresle J, Lasjaunias P.
Cranial nerve ischaemic arterial syndromes.
Brain.
1986;
109
207-216
- 11
Maitland C G, Black J L, Smith W A.
Abducens nerve palsy due to spontaneous dissection of the internal carotid artery.
Arch Neurol.
1983;
40
448-449
- 12
van Overbeeke J J, Jansen J J, Tulleken C A.
The cavernous sinus syndrome. An anatomical and clinical study.
Clin Neurol Neurosurg.
1988;
90
311-319
- 13
Koennecke H, Seyfert S.
Mydriatic pupil as the presenting sign of common carotid artery dissection.
Stroke.
1998;
29
2653-2655
- 14
Hegde V, Coutinho C M, Mitchell J D.
Dissection of the intracranial internal carotid artery producing isolated oculomotor
nerve palsy with sparing of pupil.
Acta Neurol Scand.
2002;
105
330-332
- 15
Borruat F X, Bogousslavsky J, Uffer S et al.
Orbital infarction syndrome.
Ophthalmology.
1993;
100
562-568
- 16
Lyrer P, Engelter S.
Antithrombotic drugs for carotid artery dissection.
Cochrane Database Syst Rev.
2010;
10
CD000255
Sascha Alvermann
Borromäus Hospital, Unfall- und Wiederherstellungschirurgie
Kirchstr. 61–67
26789 Leer
eMail: sascha_alvermann@gmx.de
