以认知障碍为主要表现的颈内动脉狭窄临床分析

Clinical analysis of internal carotid artery stenosis with cognitive impairment as the main manifestation

目的探讨以认知障碍为主要表现的颈内动脉狭窄的临床特点和治疗效果,减少误诊,漏诊。方法收集2018-01—2020-06在焦煤集团中心医院神经内科接受治疗的13例以认知障碍为主要表现的颈内动脉狭窄患者的临床资料,并进行回顾性分析。结果13例患者中临床表现为记忆力下降13例(100%),精神症状5例(38.5%),定向障碍7例(53.8%),计算力下降9例(69.2%),社交能力下降11例(84.6%)。13例颈部彩超显示颈动脉狭窄;10例头颈CTA显示单侧颈内动脉狭窄,3例头颈CTA显示双侧颈内动脉狭窄;10例DSA显示单侧颈内动脉狭窄,3例DSA显示双侧颈内动脉狭窄,其中1例DSA显示双侧颈内动脉狭窄合并同侧大脑中动脉狭窄。6例行保护伞下颈内动脉狭窄球囊扩张+支架成形术,7例给予阿司匹林肠溶片+氯吡格雷片双抗治疗。13例中6例基本痊愈,2例明显好转,4例遗留不同程度认知障碍,1例进展性脑梗死死亡。结论以认知障碍为主要临床表现的颈内动脉狭窄发生率低,容易误诊,漏诊,颈部彩超、CTA、DSA确诊率高。一旦确诊及时给予双抗治疗或支架植入可显著改善预后。

Objective To investigate the clinical characteristics and treatment effect of internal carotid artery stenosis with cognitive impairment as the main manifestation,so as to reduce misdiagnosis and missed diagnosis.Methods The clinical data of 13 patients with internal carotid artery stenosis who were treated in Department of Neurology,Central Hospital of Coking Coal Group from January 2018 to June 2020 were collected and analyzed retrospectively.Results Among the 13 cases,13 cases(100%)had clinical manifestations of memory decline,5 cases(38.5%)had mental symptoms,7 cases(53.8%)had disorientation,9 cases(69.2%)had decreased computational power,11 cases(84.6%)had decreased social ability.Thirteen cases had carotid artery stenosis.Ten cases had unilateral internal carotid artery stenosis by head and neck CTA,3 cases had bilateral internal carotid artery stenosis by head and neck CTA.Ten cases had unilateral internal carotid artery stenosis by DSA,3 cases showed bilateral internal carotid artery stenosis,of which 1 case showed bilateral internal carotid artery stenosis combined with ipsilateral middle cerebral artery stenosis by DSA.Six cases were treated with balloon dilatation and stenting under protective umbrella,7 cases were treated with aspirin enteric coated tablets and clopidogrel tablets.Six cases of 13 cases were basically cured,2 cases were significantly improved,4 cases were left with different courses,1 patient died of progressive cerebral infarction.Conclusion Internal carotid artery stenosis with cognitive impairment as the main clinical manifestation has low incidence,easy to be misdiagnosed and missed diagnosis.The diagnosis rate of carotid artery stenosis by color Doppler ultrasound,CTA and DSA is high.Once the diagnosis is confirmed,double antibody therapy or stent implantation can significantly improve the prog⁃nosis.