Clinical characteristics of symptomatic vertebral artery dissection: a systematic review.
Clinical characteristics of symptomatic vertebral artery dissection: a systematic review.
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DOI：
10.1097/nrl.0b013e31826754e1
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发表时间：
2012-09
期刊：
影响因子：
--
通讯作者：
Newman-Toker DE
中科院分区：
文献类型：
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作者：
Gottesman RF;Sharma P;Robinson KA;Arnan M;Tsui M;Ladha K;Newman-Toker DE
椎动脉夹层（VAD）是年轻人中风的重要原因。它可以表现为非特异性，并可能被误诊为不良后果。我们评估了症状性VAD患者的头颈部疼痛、其他神经系统症状和脑血管事件的频率。我们对观察性研究进行了系统回顾，在电子数据库（MEDLINE，EMBASE）中搜索了5例以上具有VAD临床或放射学特征的受试者的英文手稿。两名独立评审员选择纳入研究;第三名评审员裁定差异。评估研究的方法学质量，并提取临床数据。计算合并比例。在3996篇引文中，我们筛选了511篇手稿，并选择了75篇描述1,972例VAD患者的研究。最常见的症状是头晕/眩晕（58%），头痛（51%）和颈部疼痛（46%）。卒中常见（63%），尤其是颅外夹层（66% vs. 32%，p<0.0001），而TIA（14%）和蛛网膜下腔出血（SAH）（10%）不常见。SAH仅见于颅内夹层（57% vs. 0%，p=0.003）。不到一半的患者有明显的创伤，只有7.9%的患者有已知的结缔组织疾病。67%的患者结局良好（改良兰金量表（mRS）0-1），10%的患者结局较差（mRS 5-6）。VAD与非特异性症状相关，如头晕、眩晕、头痛或颈痛。缺血性卒中是最常见的脑血管并发症。在对出现头晕或颅脑疼痛的患者进行诊断评估时，即使没有其他风险因素，也应考虑VAD。未来的研究应将临床结果作为明确定义的未分化的临床VAD可疑人群的预测因素进行比较。
Vertebral artery dissection (VAD) is an important cause of stroke in the young. It can present nonspecifically and may be misdiagnosed with adverse consequences. We assessed the frequency of head/neck pain, other neurological symptoms, and cerebrovascular events in symptomatic VAD. We conducted a systematic review of observational studies, searching electronic databases (MEDLINE, EMBASE) for English-language manuscripts with >5 subjects with clinical or radiological features of VAD. Two independent reviewers selected studies for inclusion; a third adjudicated differences. Studies were assessed for methodological quality and clinical data were abstracted. Pooled proportions were calculated. Of 3996 citations, we screened 511manuscripts and selected 75 studies describing 1,972 VAD patients. The most common symptoms were dizziness/vertigo (58%), headache (51%) and neck pain (46%). Stroke was common (63%), especially with extracranial dissections (66% vs. 32%, p<0.0001), while TIA (14%) and subarachnoid hemorrhage (SAH) (10%) were uncommon. SAH was seen only with intracranial dissections (57% vs. 0%, p=0.003). Fewer than half of the patients had obvious trauma, and only 7.9% had a known connective tissue disease. Outcome was good (modified Rankin scale (mRS) 0-1) in 67% and poor (mRS 5-6) in 10%. VAD is associated with nonspecific symptoms such as dizziness, vertigo, headache, or neck pain. Ischemic stroke is the most common reported cerebrovascular complication. VAD should be considered in the diagnostic assessment of patients presenting with dizziness or craniocervical pain, even in the absence of other risk factors. Future studies should compare clinical findings as predictors in well-defined, undifferentiated populations of clinical VAD suspects.