Vertebral Artery Fenestration Mimicking Acute Dissection
Vertebral Artery Fenestration Mimicking Acute Dissection
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模拟急性解剖的椎动脉开窗术
DOI：
10.1002/ana.25800
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发表时间：
2020
影响因子：
11.2
通讯作者：
Stefano Tamburin
中科院分区：
文献类型：
--
作者：
C. Zivelonghi;A. Emiliani;N. Micheletti;Stefano Tamburin
图：一名42岁女性因持续呕吐和头痛2天就诊于急诊科。血液检查和胃肠道检查都没有异常。患者行脑CT扫描和CT血管造影显示双腔（红圈）右(R)椎动脉（VA）和左(L)颈内动脉（ICA）发育不全（用“？”表示）， A组；颈外动脉[ECA])。神经系统检查正常，脑磁共振成像（MRI）未见脑缺血或任何病理征象。患者被诊断为室间隔夹层，并开始使用华法林。在2年的随访中，双腔扫描显示C4-C2段持续双腔右心室，两支血管血流正常（B图）。CT血管造影结果与2年前相同，3D CT血管造影重建显示，在C4-C2节段有2条血管重复VA，呈梭状外观（箭头，C面板）。mri血管造影排除慢性室间隔夹层，因为在轴向图像中没有血管内血肿的证据（白色圆圈，图D）。这些发现促使重新考虑诊断为先天性VA开窗与ICA发育相关，并停止抗凝治疗。在1年的进一步随访中，患者没有报告新的症状，神经系统检查也没有明显变化。[彩图可于www.annalsofneurology.org浏览]
FIGURE: A 42-year-old woman presented to the emergency department with persisting vomiting and headache for 2 days. Blood tests and gastrointestinal work-up were unremarkable. The patient underwent brain computed tomography (CT) scan and CT-angiogram that showed double-lumen (red circle) right (R) vertebral artery (VA) and left (L) internal carotid artery (ICA) agenesis (indicated by “?”, panel A; external carotid artery [ECA]). Neurological examination was normal and brain magnetic resonance imaging (MRI) did not document brain ischemia or any pathological sign. The patient was diagnosed with VA dissection and started on warfarin. At 2-year follow-up, duplex scan showed persistent double-lumen right VA in the C4-C2 segment with orthodromic blood flow in both vessels (panel B). The CT angiogram findings were the same as 2 years before and the 3D CT angiogram reconstruction showed VA duplication into two vessels in the C4-C2 segment with fusiform appearance (arrowheads, panel C). MRI-angiogram ruled out chronic VA dissection, because no evidence of intramural hematoma in axial images (white circle, panel D). These findings prompted reconsideration of the diagnosis as congenital VA fenestration associated with ICA agenesis and to discontinue anticoagulation. At 1-year further follow-up, the patient reported no new symptoms and neurological examination was unremarkable. [Color figure can be viewed at www.annalsofneurology.org]