脑动脉夹层所致急性脑梗死/短暂性脑缺血发作患者的临床及影像学特征研究  

Clinical and Imaging Features of Acute Cerebral Infarction/Transient Ischemic Attack Caused by Cerebral Artery Dissection

作　　者：张晓[1] 杨伊姝[1] 刘占东[1] ZHANG Xiao;YANG Yi-shu;LIU Zhan-dong(Department of Neurology&Medical Insurance Center,Beijing Friendship Hospital of Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院医保中心神经内科,北京市100050

出　　处：《实用心脑肺血管病杂志》2018年第9期33-37,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探讨脑动脉夹层所致急性脑梗死/短暂性脑缺血发作(TIA)患者的临床及影像学特征。方法选取2013年6月—2018年5月北京友谊医院神经内科收治的脑动脉夹层所致急性脑梗死/TIA患者18例,回顾性分析其临床资料,包括性别、年龄、夹层类型、夹层部位、夹层动脉瘤发生情况、脑血管病高危因素、临床表现、梗死部位、梗死机制、影像学表现、治疗方法及预后等。结果 (1)18例患者中男14例,女4例;年龄32~78岁,平均年龄(60.7±14.2)岁;夹层类型:自发性脑动脉夹层17例,创伤性脑动脉夹层1例;夹层部位:颈动脉夹层10例,椎-基底动脉夹层8例;发生夹层动脉瘤3例;16例有脑血管病高危因素。(2)临床表现:2例TIA患者以头痛起病,16例急性脑梗死患者发病前无任何先兆症状;16例急性脑梗死患者中出现肢体无力9例,头晕8例,肢体麻木6例,构音障碍6例,吞咽障碍2例,头痛2例,意识障碍2例,视力障碍1例。(3)梗死部位:16例急性脑梗死患者中前循环梗死9例,后循环梗死7例;梗死机制:栓塞性梗死9例,穿支闭塞性梗死4例,血流动力性梗死3例。(4)影像学表现:18例患者中14例行头颈部CT血管成像(CTA)检查,11例行数字减影血管造影(DSA)检查,2例行磁共振血管成像(MRA)检查;共发现狭窄6例,闭塞5例,"新月征"5例,"动脉瘤"样改变3例,典型"鼠尾征"2例,"双腔征"1例,"串珠"样改变1例。(5)治疗方法:18例患者中15例采用抗血小板治疗,1例采用抗凝治疗,1例采用动静脉联合溶栓治疗,1例采用动脉溶栓治疗;预后:2例患者死亡,余16例患者随访3~6个月,其中1例椎动脉夹层患者出现复发性脑梗死。结论脑动脉夹层所致急性脑梗死/TIA以青中年多见,以自发性脑动脉夹层为主并常伴有脑血管病危险因素,但无特异性临床表现,起病初期可无临床症状或仅表现为单纯头颈部疼痛,影像学表现以闭塞及狭窄最常见,一般采用积极抗凝或抗�Objective To explore the clinical and imaging features of acute cerebral infarction/transient ischemic attack(TIA)caused by cerebral artery dissection.Methods From June 2013 to May 2018,medical records of 18 patients with acute stroke or TIA caused by cerebral artery dissection were retrospectively analyzed in the Department of Neurology,Beijing Friendship Hospital of Capital Medical University,including gender,age,types of dissection,location of dissection,incidence of dissection aneurysm,high risk factors of cerebrovascular disease,clinical manifestations,location of infarction,mechanism of infarction,imaging findings,therapeutic methods and prognosis.Results (1)The mean age of the 18 patients was(60.7±14.2)years,including 14 men and 4 women.There were 17 cases of spontaneous cerebral artery dissection,1 case of traumatic cerebral artery dissection;10 cases of carotid artery dissection,8 cases of vertebral-basilar artery dissection;3 cases of dissection aneurysm;16 cases with high risk factors of cerebrovascular disease.(2)2 patients with TIA were onset of headache,16 patients with acute cerebral infarction without any precursory symptoms;among the 16 patients with acute cerebral infarction,9 cases performed as limb weakness,8 cases performed as dizziness,6 cases performed as limb numbness,6 cases performed as dysarthria,2 cases performed as dysphagia,2 cases performed as headache,2 cases performed as disturbance of consciousness,and 1 case performed as visual impairment.(3)Among the 16 patients with acute cerebral infarction,there were 9 cases of anterior circulation infarction,7 cases of posterior circulation infarction;9 cases of embolic infarction,4 cases of perforative and occlusive infarction,and 3 cases of hemodynamic infarction.(4)Of the 18 patients,14 cases were examined by CTA of head and neck,11 cases by DSA,2 cases by MRA.There were 6 cases of stenosis,5 cases of occlusion,5 cases of crescent sign,3 cases of aneurysmal change,2 cases of typical rat-tail sign,1 case of double lumen signs and 1 case

关 键 词：卒中 脑缺血 动脉瘤 夹层 疾病特征 

分 类 号：R743[医药卫生—神经病学与精神病学] R543.16[医药卫生—临床医学]