Pregnancy as a Subgroup in the Pathophysiologic Classification of Spinal Aneurysms
Pregnancy as a Subgroup in the Pathophysiologic Classification of Spinal Aneurysms
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DOI：
10.1016/j.wneu.2021.10.067
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发表时间：
2021-12-15
影响因子：
2
通讯作者：
Chaalala, Chiraz
中科院分区：
文献类型：
--
作者：
Bojanowski, Michel W.;Stefanovic, Katarina;Chaalala, Chiraz
背景：与任何已知的诱发条件无关的脊髓动脉瘤被称为孤立性脊髓动脉瘤（SA）。在我们的系列中，SA被发现在2例患者在产后期间。本研究的目的是确定SA的发生是否可能与产褥期相关。方法：回顾性分析了2008年至2020年连续10例SA病例，我们确定了2例产褥期SA病例。对患者的病历和影像学检查进行了审查，以确定潜在的诱发因素。结果：在这两个病例中，血管造影显示SA前部梭形动脉瘤伴双侧椎动脉（VA）夹层。血清血管炎和炎症面板和胶原蛋白紊乱的基因检测均为阴性。文献综述表明，妊娠与不同部位动脉夹层风险增加相关，并支持血流动力学和激素变化可能在SA形成中发挥作用的假设。- 结论：妊娠和围产期状态可能是SA形成的独特原因，可能是血流动力学应激增加和激素变化改变动脉壁的结果。在SA的分类中，将妊娠作为一个亚组添加是适当的。在我们的系列中，两例病例均与双侧VA夹层相关;双侧VA狭窄可能促成了SA的形成。在考虑VA夹层闭塞时，认识到这种可能性很重要。
-BACKGROUND: Aneurysms of spinal arteries not associated with any known predisposing condition are referred to as isolated spinal aneurysms (SAs). In our series, an SA was found in 2 patients during the postpartum period. The goal of this study is to determine whether an occurrence of an SA may be related to puerperium. -METHODS: In a retrospective analysis of our consecutive series of 10 cases of SAs from 2008 to 2020, we identified 2 cases of SAs during puerperium. Patients' charts and imaging were reviewed, for potential predisposing factors. -RESULTS: In both cases, angiography showed fusiform aneurysms of the anterior SA with concomitant bilateral vertebral artery (VA) dissections. Serum vasculitis and inflammatory panel and genetic testing for collagen disorders were negative in both cases. Review of the literature showed that pregnancy is associated with an increased risk of arterial dissections in various locations and supports the hypothesis that hemodynamic and hormonal changes may play a role in the formation of SAs. -CONCLUSIONS: Pregnancy and peripartum state may be a distinct cause of the formation of SAs, possibly as a result of increased hemodynamic stress and hormonal changes that may alter the arterial wall. It would be appropriate to add pregnancy as a subgroup in the classification of SAs. In our series, both cases were associated with bilateral VA dissections; it is possible that the bilateral VA stenosis may have contributed to the formation of the SAs. It is important to recognize this possibility when considering the occlusion of a dissected VA.