Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection
Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection
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DOI：
10.1159/000452303
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发表时间：
2016-01-01
影响因子：
2.4
通讯作者：
Drescher, Robert
中科院分区：
文献类型：
--
作者：
Gunther, Albrecht;Witte, Otto W.;Drescher, Robert
背景/目的：椎动脉夹层（VAD）是缺血性中风的重要原因。在这项观察性研究中，分析了临床数据、磁共振 (MR) 和超声 (US) 成像结果以及缺血模式。方法：47 例诊断为 VAD 的患者接受了临床检查、超声检查、脑颈部 MR 以及颈动脉 MR 血管造影 (MRA)。注意到血管异常和缺血性脑损伤。单独评估数据并比较自发性和创伤性 VAD 亚组。结果：最常见的总体临床症状是眩晕，其次是颈部疼痛。在创伤亚组中，眩晕相对罕见（p = 0.022）。最常见的 MRA 结果是血管不规则和血管闭塞。自发性 VAD 后缺血性病变的发生率明显高于创伤性 VAD 后 (p = 0.009)。单侧 VAD 在非优势椎动脉中更为常见 (p < 0.001)。创伤后的死亡不仅是由于 VAD 并发症，而且是由于其他创伤相关损伤。结论：说明了 VAD 患者 MR 和 US 成像结果的变异性。管理流程应基于涉及患者病史和临床神经学检查的多模式方法。多种类型的血管异常和不同部位的缺血性病变可能提示动脉夹层，必须牢记 VAD 的鉴别诊断。 (C) 2016 S. Karger AG，巴塞尔
Background/Aims: Vertebral artery dissection (VAD) is an important cause of ischemic stroke. In this observational study, clinical data, magnetic resonance (MR) and ultrasound (US) imaging findings and ischemic patterns were analyzed. Methods: Forty-seven patients with a diagnosis of VAD underwent clinical examination, US, MR of the brain and neck and MR angiography (MRA) of the cervical arteries. Vascular abnormalities and ischemic brain lesions were noted. Data were evaluated separately and compared for spontaneous and traumatic VAD subgroups. Results: The most common overall clinical symptom was vertigo followed by neck pain. In the traumatic subgroup, vertigo was relatively rare (p = 0.022). Most common MRA findings were vessel irregularity and vessel occlusions. Ischemic lesions occurred significantly more frequently after spontaneous than after traumatic VAD (p = 0.009). Unilateral VAD was significantly more common in non-dominant vertebral arteries (p < 0.001). Mortality after trauma was not only due to VAD complications but also due to other trauma-related injuries. Conclusion: The variability of MR and US imaging findings in patients with VAD is illustrated. The algorithm of management should be based on a multimodality approach involving patient history and clinical neurological examination. Several types of vessel abnormalities and ischemic lesion in diverse locations may point to arterial dissection, and the differential diagnosis of VAD must be kept in mind. (C) 2016 S. Karger AG, Basel