头颈部动脉夹层18例影像和临床特点、治疗及随访  

Morphology and clinical features in 18 patients with cervicocerebral artery dissection and follow-up

作　　者：陈云波[1] 

机构地区：[1]自贡市第四人民医院神经内科,四川自贡643000

出　　处：《中风与神经疾病杂志》2014年第7期628-632,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的 探讨自发性头颈部动脉夹层（包括颈动脉及椎动脉夹层）的影像学特点及其治疗随访情况。方法 对18例自2009年~2013年于我科住院诊断为急性脑梗死/TIA,后经检查证实自发性头颈部动脉夹层患者的影像学特点、病因、临床特点及治疗随访情况进行分析。结果 11例颈动脉夹层及7例椎动脉夹层患者的发病高危因素包括近期上呼吸道感染、颈部按摩、颈部轻微外伤、偏头痛、结缔组织疾病、长期吸烟、高血压等。DSA检查5例表现为线样征,1例可见血管内膜瓣,3例表现为双腔征,8例表现为火焰征,17例患者表现为脑梗死,1例表现为TIA,2例患者伴有头颈部疼痛,1例患者伴有Horner征。3例患者接受抗凝治疗,15例患者接受抗血小板聚集治疗,其中1例伴有明显血流动力学障碍行支架植入术。所有患者在3~6 m的随访过程中未发生新的缺血事件。结论 依据典型的临床表现及影像学表现可帮助诊断头颈部动脉夹层,口服抗凝及抗血小板聚集治疗是目前首选治疗方案,部分伴有明显血流动力学障碍的狭窄病例可尝试支架置入术。Objective To investigate the morphology and clinical features of patients diagnosed as spontaneous cer- vicocerebral artery dissection（ CVD）, and evaluate the follow-up. Methods Eighty in-patient cases during 2009 ~ 2013 diagnosed as CVD were included for research, the clinical and morphology features, risk factors, the 6 months follow-up were analyzed. Results The risk factors in all 11 cases of cervical artery dissection and 7 cases of vertebral artery dissection in- cluded recent upper respiratory tract infection, migrane, connective tissue disease, smoke, hypertension, chiropractic manipu- lation,trivial cervical trauma. DSA features were revealed as ＂string sign＂ in 5 cases,＂ intimal flap＂ in 1 cases,＂ double lumen＂ in 3 cases,＂flame-shaped＂ in 8 cases. 17 cases were diagnosed as ischemic stroke and 1 case was diagnosed as TIA. 2 patients presented with unilateral headache or neck pain, 1 patient presented with honor sign. Anticoagulation treat- ment was given in 3 cases and anti-platelet treatment was given in 15 cases, one of the 3 patients received anti-platelet treat- ment was underwent cervical stenting operation to resolve the hemodynamic insufficiency. Conclusions Diagnosis of cervi- coeerebral artery dissection is based on the typical clinical manifestations and morphology featrues. Anticoagulation and an- ti-platelet are the first line treatment in CVD. Stent in-planted operation should be considered in CVD cases with hemody- namic insufficiency.

关 键 词：颈动脉狭窄 动脉夹层 血小板聚集抑制剂 

分 类 号：R743[医药卫生—神经病学与精神病学]