袁萍;靳利敏;

• 1:郑州大学第一附属医院

摘要(Abstract)：

目的对比分析颈内动脉夹层与椎动脉夹层的临床表现及危险因素。方法前瞻性收集2011-01—2019-10年于郑州大学第一附属医院神经内科和神经介入科连续诊治的216例头颈动脉夹层患者,根据夹层累及部位将患者分为颈内动脉夹层组和椎动脉夹层组,分析2组患者的临床表现及危险因素的差异。结果 216例患者中颈内动脉夹层组100例,椎动脉夹层组116例。颈内动脉夹层组缺血性脑卒中患者NIHSS评分较高(3.9±5.2分比1.9±2.0分,P<0.001),而椎动脉夹层组患者多有头痛(67.2%比37.0%,P<0.001),轻微创伤史(14.7%比8.0%,P=0.021),并易出现SAH(24.1%比3.0%,P<0.001)。结论颈内动脉夹层缺血性脑卒中症状较重,椎动脉夹层更易出现头痛症状以及蛛网膜下腔出血,既往多有轻微创伤史。

关键词(KeyWords)： 头颈动脉夹层;颈内动脉夹层;椎动脉夹层;临床表现;危险因素

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金面上项目(编号:81771397)

作者(Authors): 袁萍;靳利敏;

参考文献(References)：

• [1] GROND-GINSBACH C,METSO T M,METSO A J,et al.Cervical artery dissection goes frequently undiagnosed[J].Med Hypotheses,2013,80(6):787-790.DOI:10.1016/j.mehy.2013.03.012.
• [2] PUTAALA J,METSO A J,METSO T M,et al.Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke:the Helsinki young stroke registry[J].Stroke,2009,40(4):1195-1203.DOI:10.1161/STROKEAHA.108.529883.
• [3] DEBETTE S,LEYS D.Cervical-artery dissections:predisposing factors,diagnosis,and outcome[J].Lancet Neurol,2009,8(7):668-678.DOI:10.1016/S1474-4422(09)70084-5.
• [4] SONG J X,LIN X M,HAO Z Q,et al.Ocular manifestations of internal carotid artery dissection[J].Int J Ophthalmol,2019,12(5):834-839.DOI:10.18240/ijo.2019.05.21.
• [5] FUSCO M R,HARRIGAN M R.Cerebrovascular dissections--a review part I:Spontaneous dissections[J].Neurosurgery,2011,68(1):242-257,257.DOI:10.1227/NEU.0b013e3182012323.
• [6] HAKIMI R,SIVAKUMAR S.Imaging of Carotid Dissection[J].Curr Pain Headache Rep,2019,23(1):2.DOI:10.1007/s11916-019-0741-9.
• [7] PARWAR B L,FAWZI A A,ARNOLD A C,et al.Horner's syndrome and dissection of the internal carotid artery after chiropractic manipulation of the neck[J].Am J Ophthalmol,2001,131(4):523-524.DOI:10.1016/s0002-9394(00)00829-1.
• [8] METSO T M,DEBETTE S,GROND-GINSBACH C,et al.Age-dependent differences in cervical artery dissection[J].J Neurol,2012,259(10):2202-2210.DOI:10.1007/s00415-012-6485-7.
• [9] VON BABO M,DE MARCHIS G M,SARIKAYA H,et al.Differences and similarities between spontaneous dissections of the internal carotid artery and the vertebral artery[J].Stroke,2013,44(6):1537-1542.DOI:10.1161/STROKEAHA.113.001057.
• [10] SCHIEVINK W I,MOKRI B,PIEPGRAS D G,et al.Recurrent spontaneous arterial dissections:risk in familial versus nonfamilial disease[J].Stroke,1996,27(4):622-624.DOI:10.1161/01.str.27.4.622.
• [11] WINSVOLD B S,MARVIK A,ZWART J A,et al.Migraine and stroke[J].Tidsskr Nor Laegeforen,2018,138(4).DOI:10.4045/tidsskr.17.0347.
• [12] BRANDT T,HAUSSER I,ORBERK E,et al.Ultrastructural connective tissue abnormalities in patients with spontaneous cervicocerebral artery dissections[J].Ann Neurol,1998,44(2):281-285.DOI:10.1002/ana.410440224.
• [13] UHLIG P,BRUCKNER P,DITTRICH R,et al.Aberrations of dermal connective tissue in patients with cervical artery dissection (sCAD)[J].J Neurol,2008,255(3):340-346.DOI:10.1007/s00415-008-0585-4.
• [14] PAULUS J K,THALER D E.Does case misclassification threaten the validity of studies investigating the relationship between neck manipulation and vertebral artery dissection stroke?Yes[J].Chiropract Man Ther,2016,24(1):42.DOI:10.1186/s12998-016-0123-x.
• [15] BLUM C A,YAGHI S.Cervical Artery Dissection:A Review of the Epidemiology,Pathophysiology,Treatment,and Outcome[J].Arch Neurosci,2015,2(4).DOI:10.5812/archneurosci.26670.
• [16] ENGELTER S T,GROND-GINSBACH C,METSO T M,et al.Cervical artery dissection:trauma and other potential mechanical trigger events[J].Neurology,2013,80(21):1950-1957.DOI:10.1212/WNL.0b013e318293e2eb.
• [17] MAYER L,BOEHME C,TOELL T,et al.Local Signs and Symptoms in Spontaneous Cervical Artery Dissection:A Single Centre Cohort Study[J].J Stroke,2019,21(1):112-115.DOI:10.5853/jos.2018.03055.
• [18] GALLERINI S,MARSILI L,BARTALUCCI M,et al.Headache secondary to cervical artery dissections:practice pointers[J].Neurol Sci,2019,40(3):613-615.DOI:10.1007/s10072-018-3576-y.
• [19] WANG Y,CHENG W,LIAN Y,et al.Characteristics and relative factors of headache caused by cervicocere-bral artery dissection[J].J Neurol,2019,266(2):298-305.DOI:10.1007/s00415-018-9111-5.
• [20] DEBETTE S,GROND-GINSBACH C,BODENANT M,et al.Differential features of carotid and vertebral artery dissections:the CADISP study[J].Neurology,2011,77(12):1174-1181.DOI:10.1212/WNL.0b013e31822f03fc.
• [21] SCHAUMBERG J,LETTOW I,ECKERT B,et al.Cranial nerve palsy and ageusia caused by carotid artery dissection[J].Nervenarzt,2015,86(10):1268-1269.DOI:10.1007/s00115-015-4399-1.
• [22] ENGLISH S W,PASSE T J,LINDELL E P,et al.Multiple cranial neuropathies as a presentation of spontaneous internal carotid artery dissection:A case report and literature review[J].J Clin Neurosci,2018,50:129-131.DOI:10.1016/j.jocn.2018.01.056.