与中耳炎导致同侧颈内动脉闭塞相关的颈内动脉C1段炎性动脉瘤：一例病例报告及文献综述。

文献信息

中文摘要

背景： 颈内动脉闭塞（ICAO）是一种非常严重的脑血管疾病，由感染引起的ICAO极为罕见。我们报告一例极为罕见的同侧颈内动脉C1段炎性动脉瘤，由中耳炎（OM）引起，并伴有同侧ICAO。
病例介绍： 一名59岁女性因发热和头痛40天就诊于急诊科，症状在过去30天内加重，并伴有言语含糊和右侧面部麻木。入院时，头颈部CTA显示右侧颈内动脉（ICA）C1段近完全闭塞，并伴有远端巨大动脉瘤。根据实验室结果、病史和体格检查，患者被诊断为严重OM继发颅内感染；脑脊液（CSF）分析显示人疱疹病毒4型（EBV）阳性。经过多学科会诊，通过调整用药以及抗生素和抗病毒药物治疗，患者症状改善。随访CTA显示动脉瘤消退，ICA进展为长段闭塞。未发现缺血性神经功能缺损。CSF分析显示EBV病毒滴度显著降低。出院后6个月，未观察到复发或新症状的迹象。
结论： 本病例强调了一条连接OM、血管炎、动脉瘤形成和ICAO的不常见病理途径。该疾病的病因和临床进展极为复杂；及时识别和积极控制感染至关重要。

英文摘要

BACKGROUND: Internal carotid artery occlusion (ICAO) is a very serious cerebrovascular disease, and ICAO caused by infection is extremely rare. We report a case of an extremely rare inflammatory aneurysm of the C1 segment of the ipsilateral internal carotid artery, caused by otitis media (OM), accompanied by ipsilateral ICAO.
CASE PRESENTATION: A 59-year-old woman presented to the emergency department with a 40-day history of fever and headache, which had worsened over the past 30 days and was accompanied by slurred speech and numbness in the right side of her face. Upon admission, a head and neck CTA revealed near-total occlusion of the right internal carotid artery (ICA) at the C1 segment with a massive distal aneurysm. The patient was diagnosed with severe OM with secondary intracranial infection by laboratory results, medical history and physical examination; cerebrospinal fluid (CSF) analysis was positive for human herpesvirus type 4 (EBV). Following multidisciplinary consultation, the patient's symptoms improved with medication adjustment and treatment with antibiotics and antiviral agents. Follow-up CTA demonstrated resolution of the aneurysm and progression of the ICA to long-segment occlusion. No ischemic neurological deficits were noted. CSF analysis showed marked reduction in EBV viral titer. At 6 months post-discharge, there were no indications of recurrence or new symptoms observed.
CONCLUSION: This case underscores an uncommon pathological route connecting OM, vasculitis, aneurysm development, and ICAO. The etiology and clinical progression of this ailment are exceedingly intricate; prompt identification and vigorous infection management are essential.