患有無症狀性頸動脈阻塞之病患進行腰椎手術後引起致命的缺血性中風之病例報告

Fatal Ischemia Stroke in a Patient with an Asymptomatic Carotid Artery Occlusion after Lumbar Spine Surgery-- A Case Report

在毫無症狀的病患術前即能察覺出有頸動脈狹窄是非常困難的，我們報告一位有糖尿病與高血壓的63歲女性病患，在進行俯姿的腰椎手術後，因為左側頸動脈完全阻塞而發生致命的缺血性中風，術中施行於病患的誘導性低血壓及頸部扭轉應該是誘發因子。然而學界並不建議廣泛性的做頸動脈狹窄的篩檢，因此這些擁有中風風險因子的病患，進行俯姿腰椎手術時，更加謹慎的施行誘導性低血壓，小心擺放頸部姿勢外，手術中使用腦電圖，體感覺誘發電位等儀器來監測腦部功能，或許能避免類似的事情發生。

Recognizing carotid artery stenosis (CAS) in an asymptomatic patient preoperatively is difficult. We report a 63-year-old female who had diabetes mellitus and hypertension suffered from a fatal ischemic stroke secondary to a total occlusion of the left carotid artery after a lumbar spine surgery in the prone position. Intraoperative induced hypotension and neck rotation in this patient should be considered as contributory factors. According to previous studies extensively screening out CAS is not recommended. Using electroencephalography (EEG) or somatosensory evoked potential (SSEP) to monitor brain function and carefully positioning of the neck are recommended in these patients who are at risk of stroke while receiving induced hypotension during lumbar spine surgery in the prone position.