Bilateral borderzone infarction and carotid artery dissection in the patient with the history of esophageal cancer.

초록

Purpose : Spontaneous cervical carotid dissection is a rare and severe disease with high mortality, which is one ofimportant causes of young age stroke. The main pathophysiology of carotid dissection is a tear in the intimal liningof the artery, which leads to luminal stenosis or occlusion, intra-arterial thrombus formation and finally strokeassociated with either hypoperfusion or artery-to-artery embolism. We present a case of bilateral cervical carotidartery dissection presenting with bilateral borderzone infarction and status epilepticus. Methods : A 56-year-old man with esophageal cancer presented with status epilepticus and quadriplegia. Theinitial brain MR/CT scans indicated the acute cerebral infarction in bilateral MCA-ACA borderzone area with intimalflaps in bilateral cervical carotid artery. However, there was no steno-occlusion in the intracranial arteries. After thecontrol of convulsion, his mentality became recovered but he had the quadriplegia. No trauma-related skin orcervical lesions were found. The patient also had the massive hematochezia and we could not try anyantithrombotics or intervention. Results : The incidence of spontaneous carotid artery dissection is estimated at around thirty per million and theincidence of bilateral carotid dissections is considered very rare and is not fully known, but may be as high as 22%of cervical carotid dissection. Several reports suggested that the radiation for esophageal cancer were associatedwith carotid blowout syndrome, carotid artery stenosis or dissections. Conclusions : Therefore, carotid artery dissection or stenosis should be considered for the treatment in patientswith the medical history of radiation around cervical area.