椎动脉夹层的治疗效果探讨

The clinical characteristics of vertebrobasilar artery dissection

目的:总结椎动脉夹层所致疾病的临床特点。方法:对16例经全脑数字减影血管造影(DSA)或CT血管造影(CTA)证实的椎动脉夹层患者的临床资料进行分析。结果:16例患者均通过DSA诊断椎动脉夹层。其中临床表现为头痛者12例,其中枕部疼痛者7例;颈部疼痛者3例,其中颈强直2例;Wallenberg综合征9例,其中不全表现者6例;恶心呕吐9例;头晕8例;行走不稳4例。影像经DSA检查本组呈"串珠"征者15例;"双腔"征1例。诊断脑干梗死7例,其中延髓梗死6例;蛛网膜下腔出血3例;颅内未见病变6例。6例采取内科治疗,症状好转未再复发;9例采用介入治疗,术后均有不同程度好转,3个月至12个月复查未见复发。其中1例载瘤动脉闭塞者,术后即出现Wallenberg综合征,MRI提示延髓梗死,考虑影响小脑后下动脉(PICA)所致,予内科治疗后好转。结论:椎动脉夹层是引起后循环缺血及蛛网膜下腔出血的原因之一,临床多表现为头痛、颈痛、头晕及局部神经功能缺损症状,其中以颈、枕部痛者多见。在DSA及CTA中主要表现为:"串珠"征;"线样"征;"玫瑰花"征;"双腔"征;也可形成假性动脉瘤或者完全闭塞。以"串珠"征多见。正确识别临床征像积极进一步检查明确诊断,并及时给予必要的治疗对于改善患者预后至关重要。

Objective To summraize the clinical characteristics of disease resulted from Vertebrobasilar Artery Dissection.Methods sixteen patients of vertebrobasilar artery dissection identified by vertebrobasilar artery dissection by digital subtraction angiography(DSA) and computed tomography angiography(CTA) were retrospective analyzed.Results Sixteen patients were diagnosed as vertebrobasilar artery dissection by digital subtraction angiography(DSA).Among them 12 patients were headache,Of which occipital pain in 7 cases;neck pain in 3 cases,including 2 cases of stiff neck.9 showed Wallenberg syndrome :Incomplete performance in 6 cases;nausea and vomiting in 9 cases;dizziness 8 and walking instability in 4 cases.Digital subtraction angiography(DSA) showed pearl sign in 15 cases and Dual-chamber sign in 1cases.7 cases are brainstem infarction,among them 6 are medullary infarction.3 cases are subarachnoid hemorrhage.The other 6 cases are absolutely normal.6 cases have taken Medical treatment,and then no further recurrence of symptoms.9 cases who had Intervention were all improved in varying degrees after surgery,and all of them has no recurrence of the aneurysm in the follow-up of 3 months to 12 months.1 case occurred Wallenberg syndrome after aneurysm embolization,and Magnetic Resonance Imaging tips medullary infarction.Impacting of posterior inferior cerebellar artery(PICA) may be reason.Conclusion Vertebrobasilar Artery Dissection is one reason of posterior circulation ischemia and subarachnoid hemorrhage.The related Symptom were headache among which cervical,occipital pain were more common,dizziness,and focal neurological function deficition.In digital subtraction angiography(DSA) and computed tomography angiography(CTA) mainly performanced as follows: pearl and string sign,Rose sign,Dual-chamber sign,It can also form a false aneurysm or occlusion absolutely.Identify the vertebral artery dissection correctly and positive for the further examination and necessary treatment in time is very important in improving the patient's prognosis.