70例脑动脉夹层患者临床特点分析

Analysis of 70 Patients with Brain Artery Dissection

目的分析脑动脉夹层住院患者的临床特点,促进对脑动脉夹层的早期识别、早期诊断和治疗。方法回顾性分析首都医科大学附属北京天坛医院神经内科及神经介入科2014年12月~2015年4月经全脑血管造影或高分辨磁共振成像诊断的脑动脉夹层患者的临床特点、影像学特点及治疗措施的情况。结果共纳入70例脑动脉夹层患者。平均年龄（50.0±12.8）岁,男性52例（74%）,女性18例（26%）。颈动脉颅外段夹层21例（30%）,椎动脉段夹层30例（43%）,基底动脉夹层15例（21%）,大脑中动脉水平段夹层1例（1%）,侧裂段夹层1例（1%）。大脑后动脉及锁骨下动脉夹层各1例（1%）。非蛛网膜下腔出血性头痛19例（27%）,头晕3例（4%）,颈痛11例（16%）,缺血性卒中16例（23%）,蛛网膜下腔出血5例（7%）,短暂性脑缺血发作4例（6%）,其中3例经检查后发现缺血性卒中,无症状者19例（27%）。1例同时存在头痛和颈痛。3例患者同时存在缺血性卒中和头痛,1例患者同时存在颈痛、短暂性脑缺血发作和缺血性卒中。动脉夹层的影像学特征主要表现为动脉局部瘤样扩张、内膜瓣、动脉壁内新月形高信号征等。接受抗栓治疗者9例（13%）,单纯抗凝治疗2例（3%）,支架辅助弹簧圈填塞17例（24%）,单纯弹簧圈填塞5例（7%）,单纯支架治疗11例（16%）,抗凝结合支架治疗者1例（1%）,没有治疗者23例（33%）,死亡2例（3%）。结论脑动脉夹层的患者临床症状表现形式不同,轻症者可无症状,或单纯头颈痛,重症者可表现为短暂性脑缺血发作、缺血性卒中或蛛网膜下腔出血,正确诊断和相应的治疗十分重要。

Objective To analyze the clinical characteristics of brain artery dissection and promote the early diagnosis and treatment. Methods The clinical, neuroimaging characteristic and treatment was retrospectively analyzed. Results Totally 70 patients were analyzed. The mean age was （50.0±12.8） years old. There were 52 （74%） males and 18 （26%） females. There were 21 （30%） patients had extracranial carotid dissection, 30 （43%） had vertebral artery dissection, 15 （21%） had basilar artery dissection. There was 1 （1%） patient had dissection at horizontal segment, lateral ifssure segment, post brain artery and subclavian artery respectively. Total 19 （27%） patients had headache, 3 （4%） had dizzness, 11 （16%） had neck pain. There were 16 （23%） patients had ischemic stroke, 5 （7%） patients had subarachnoid hemorrhage （SAH）, 4 （6%） patients had transient ischemic attack （TIA） （3 patients had ischemic stroke diagnosed latterly）. One of the patients had headache and neck pain at the same time. 3 patients had ischemic stroke and headache, 1 （1%） patient had TIA, neck pain, ischemic stroke at the same time. Imaging showed dilatation like aneurysm, intial lfap, crescent high signal in the artery wall. About 9 （13%） patients had antithrombus therapy, 2 （3%） had anticoagulant therapy, 17 （24%） had coil therapy with stent assistant, 11 （16%） had stent therapy, 1 （1%） had anticoagulant＆amp;nbsp;and stent therapy. Total 23 （33%） patients had no therapy and 2 （3%） were dead. Conclusion Patients with brain artery dissection may have no symptom, or headache and neck pain, or TIA, ischemic stroke or SAH. Early diagnosis and suitable treatment are very important.