脑动脉夹层的临床特点研究  

Clinical features of cerebral artery dissection

作　　者：石际俊[1] 肖国栋[1] 章春园[1] 施蓉芳[1] 曹勇军[1] 

机构地区：[1]苏州大学附属第二医院神经内科卒中病房,215004

出　　处：《临床神经病学杂志》2014年第3期186-188,共3页Journal of Clinical Neurology

摘　　要：目的：探讨脑动脉夹层的临床特点。方法回顾性分析19例脑动脉夹层患者的临床资料。结果本组男13例，女6例；年龄28～78岁，平均（55．4±15．3）岁。有高血压11例、糖尿病2例、高同型半胱氨酸血症5例、动脉粥样硬化10例、运动相关损伤3例、梅毒性血管病1例，以及脑卒中史7例、吸烟6例。以脑梗死发病10例（分水岭梗死3例），后循环缺血发作6例，脑出血2例；表现为偏瘫7例、头晕7例、头颈部疼痛5例。脑血管DSA或CTA（1例）检查示颈动脉夹层11例（57．9％）、椎动脉夹层7例（36.8％）、锁骨下动脉夹层伴狭窄1例（5．3％），动脉双腔征4例、串珠征2例、线样征2例、假腔或假性动脉瘤1例、斑块相关夹层10例。 MRI检查发现椎动脉双腔征1例。行血管内支架植入术9例，术后动脉夹层均消失；抗血小板、他汀类药物治疗10例，动静脉溶栓治疗各1例、抗凝治疗1例。观察（8．7±5．2）个月，基本痊愈或良好预后17例（89．5％），改善2例（10．5％），均无再发脑卒中。结论脑动脉夹层多以缺血性脑卒中发病，有颈动脉粥样硬化。根据患者的病情，用血管内支架植入术或抗血小板、他汀类药物治疗的效果较好。Objective To explore the clinical features of cerebral artery dissection .Methods The clinical data of 19 patients with cerebral artery dissection were retrospectively analyzed .Results There were 13 male and 6 female in these patients;age ranged from 28 to 78 years old, the average age was（54.7 ±14.4） years.There were 11 cases of hypertension , 2 cases of diabetes , 5 cases of high homocysteine , 10 cases of atherosclerosis , 3 cases of sports-related injury , 1 case of syphilitic vascular disease , 7 cases of history of stroke , 6 cases of smoking history .The onset was cerebral infarction in 10 cases（watershed infarction 3 cases ）, posterior circulation ischemic attack in 6 cases, cerebral hemorrhage in 2 cases.The manifestation was hemiplegia in 7 cases, dizziness in 7 cases, head and neck pain in 5 cases.Cerebrovascular DSA or CTA （1 case） examination showed carotid artery dissection in 11 cases （ 57.9%）,vertebral artery dissection in 7 cases（ 36.8% ）, subclavian artery dissection with stenosis in 1 case （ 5.3%）,double lumen sign in 4 cases, beaded sign in 2 cases, string sign in 2 cases, the false lumen or pseudoaneurysm in 1 case, plaque -related dissection in 10 cases.MRI showed vertebral artery lumen sign 1 case. Arterial dissection disappeared after endovascular stenting in 9 cases;The therapy of antiplatelet and statin was in 10 cases, arteriovenous thrombolytic therapy in 1 case, and anticoagulant therapy in 1 case.After（8.7 ±5.2） months observation, the patients had basic recovery or favourable prognosis in 17 cases（89.5%）, improvement in 2 cases （10.5%）, and all of them had no stroke recurrence .Conclusions Most of patients with cerebral artery dissection can suffer ischemic stroke , and majority accompanied with carotid atherosclerosis . According to the patient＆#39;s condition, the application of endovascular stenting or antiplatelet , statin have a better curative effect .

关 键 词：脑动脉夹层 动脉粥样硬化 缺血性脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]