延髓背外侧综合征病因自发性椎动脉夹层7例临床研究

Clinical research of spontaneous vertebral artery dissection 7 cases studies

目的分析椎动脉夹层的临床表现与影像学特征,总结自发性椎动脉夹层与延髓背外侧综合征的临床关系。方法收集我科诊断的7例椎动脉夹层病例的病史资料,分析其临床表现、MRI/MRA及DSA的特点。结果7例患者均有枕颈部疼痛史,临床上均表现为延髓背外侧综合征的部分或全部症状;MRI检查发现6例表现为延髓背外侧、小脑梗死灶,1例无梗死灶;MRA/DSA检查7例均发现椎动脉颅内段(V4段)夹层:1例表现为椎动脉夹层闭塞,1例表现为线样征,其余5例表现为瘤样扩张。结论自发性椎动脉夹层发病年龄较轻,发病前通常有枕颈部疼痛。我们认为自发性椎动脉夹层是延髓背外侧综合征的重要病因,并非罕见。对表现为延髓背外侧综合征的年轻患者,及时准确的病因诊断对治疗和预后有重要影响。

Objective To analyze the clinical and radiological features of vertebral dissection and summarize the relationship of spontaneous vertebral artery dissection（sVAD） and Wallenberg syndrome.Methods Seven cases with vertebral artery dissection were gathered from our hospital,and their clinical features and the characteristics of MRI/MRA and DSA were analyzed.Results Seven patients all had occipital headache or neck pain and clinically manifested Wallenberg syndrome.Six patients manifested the dorsolateral medullary and cerebellar infarctions in MRI,however one patient had no infarction.All of sVAD occurred in vertebral intracranial segment（V4 segment）,one patient with vertebral occlusion,one patient with string sign,five patients with aneurysm expansion.Conclusions sVAD often affects young adult who presented with occipital headache or neck pain before ischemic stroke.sVAD is an important cause for Wallenberg syndrome,and prompt and correct etiological diagnosis is important for the therapy and prognosis.