Ocluzie ACC bilaterala la un pacient asimptomatic

neurologic

Alexandru AndritoiuSp. Militar Craiova

Caz clinic

S. Alexandru, 55 ani• fara acuze neurologiceAug. 2013 - descoperit la un examen Eco-

Doppler cu ocluzie bilaterala ACC

Ex clinicEx clinic

• Echilibrat CV: TA 135/85 mmHg, FC 70/min• Consult neurologic,,Frust sdr. piramidal dr (schita

Babinski)

Profilul biochimicProfilul biochimic

RMN Craniu

US Doppler CARUS Doppler CAR

ACC dreaptaACC stanga

Doppler-aa VertebraleDoppler-aa Vertebrale

AV dreapta AV stanga

Supleere prin magistralele vertebrale

Doppler aa. oftalmiceDoppler aa. oftalmice

A. Oftalmica stangaA. Oftalmica dreapta

A. oftalmica

CDI observations in the four types of circulation.Normal = normal circulation in patients without ICAO; Type 1 = forward OA, CRA, and SPCA flow; Type 2a = reverse OA and forward CRA and SPCA flow; Type 2b = reverse OA and undetectable CRA and SPCA flow; Type 3 = undetectable OA, CRA, and SPCA flow.

The 4 patterns of collateral flow via the circle of Willis to the hemisphere ipsilateral to the symptomatic ICA occlusion. PCoA indicates posterior communicating artery.

Pattern of flow via the OphA ipsilateral to the symptomatic occluded ICA in patients with a symptomatic ICA occlusion 0 to 6 months, 6 to 12 months, and 12 to 18 months after symptoms occurred. Left, Patients with a unilateral ICA occlusion (n=41). Right, Patients with a bilateral ICA occlusion (n=21).

Rutgers D et al.- Stroke 2000

Ce spune literatura medicalaCe spune literatura medicala??????????????????????????????????????????????

ConcluziiConcluzii

• Ocluzia ACC este rara si se insoteste de obicei de infarct cerebral intins la nivelul emisferului homolateral

• Ocluzia ACC/ACI bilaterala este (teoretic) incompatibila cu viata

• Rata anuala de stroke in ocluzia bilaterala ACI: 0-13%• Cazul nostru demonstreaza posibilitatea

supravietuirii in absenta unui stroke fatal, gratie rolului circulatiei colaterale functionale

• Ocluzia carotidiana bilaterala-un stimul al preconditionarii ischemice cerebrale in prevenirea leziunilor ischemice focale