脑动脉夹层与缺血性卒中

Cerebral artery dissection and ischemic stroke

脑动脉夹层(CAD)是指脑动脉内膜撕脱,导致血液流入血管壁内,形成壁内血肿。CAD可能与遗传、感染、偏头痛、高血压及外伤等因素有关。典型CAD表现为头痛、Horner综合征、同侧颅神经麻痹、短暂性脑缺血发作(TIA)、卒中。影像学检查对CAD的诊断有重要价值,数字减影血管造影(DSA)是诊断的金标准。CAD目前主要的治疗方法是药物治疗,常用抗凝或抗血小板药物治疗。少数患者经抗凝治疗6个月效果不佳,或颈动脉瘤、颈动脉重度狭窄或高度恶化的难治性CAD患者,需外科手术干预。

Cerebral artery dissection （CAD） implies an intimal tear in the wall of cerebral artery leading to the intrusion of blood into layers of the arterial wall （intramural haematoma）. CAD has been reported in association with genetic factors, infections, migraine, hypertension and trauma. Clinical manifestations of CAD include headache, Homer＇s syndrome, ipsilateral cranial nerves palsy, transient ischemic attack or stroke. Imaging examinations are very important for diagnosis of CAD. Digital subtraction angiography is the golden standard of CAD. Treatment of CAD is essentially depends on pharmacological approaches, and anticoagulant and antiplatelet agents are commonly used. Anticoagulant treatment of six month may fail in a small proportion of patients, and carotid aneurysms, surgical treatment should be performed in refractory patients with highgrade or worsening stenosis.