茎突-颈动脉综合征2例临床特征分析及文献复习

Clinical characteristics of 2 cases of styloid-carotid artery syndrome and literature review

目的 总结茎突-颈动脉综合征2例的临床特点并文献复习,以提高对该病的认识。方法 回顾性分析开封市中心医院神经内科收治的2例茎突-颈动脉综合征患者的临床表现、辅助检查及诊治经过,并通过PubMed、WOS、Embase、中国知网及维普等国内外数据库检索相关文献。综合文献结果,总结茎突-颈动脉综合征的临床特点。结果 2例经头颈CT血管成像(CTA)和茎突CT等检查确诊为短暂性脑缺血(TIA)合并茎突-颈动脉综合征。除本院收治的2例外,中英文文献共报道11例茎突-颈动脉综合征患者(截至2023年10月)。13例中,11例(84.6%)以发作性的TIA症状起病,11例(84.6%)有明显的特殊头位变化的诱发因素。该病常见临床表现为单侧肢体力弱伴或不伴感觉障碍(10例,76.9%)、言语不清(7例,53.8%)、单侧肢体感觉障碍(4例,30.7%)、晕厥(3例,23.1%)、黑曚(2例,15.4%)。13例均行64排头颈CTA检查,6例(46.2%)通过经颅多普勒超声(TCD)、颈部血管超声及数字减影血管造影(DSA)等检查动态观察了血流速度变化情况。所有患者均随访观察>3个月,10例(76.9%)经治疗后达临床治愈,其中8例行茎突截短术;3例(23.1%)经治疗后达临床症状缓解。结论 对于反复TIA或脑梗死发病患者,应了解有无特殊体位变换相关的诱发因素;对高度怀疑茎突-颈动脉综合征患者,应常规行茎突CT、64排头颈CTA检查,必要时行全脑DSA、动态TCD或颈部血管超声等检查,以指导诊治。非手术治疗效果不佳时,可考虑行茎突截短术治疗。

Objective To summarize the clinical characteristics of 2 cases of styloid-carotid syndrome(SCS)and review the literature to enhance understanding of the disease.Methods A retrospective analysis was conducted on the clinical manifestations,auxiliary examinations,and diagnosis and treatment of 2 patients with SCS admitted to the Neurology Department of Kaifeng Central Hospital.Additionally,relevant literature was searched through domestic and foreign databases such as PubMed,WOS,Embase,CNKI and VIP.The clinical characteristics of SCS were summarized based on the literature results.Results The 2 cases were diagnosed as transient cerebral ischemia(TIA)combined with SCS through head and neck CT angiography(CTA)and styloid process CT.Apart from the 2 cases treated in our hospital,a total of 11 cases of SCS have been reported in Chinese and English literature up to October 2023.Among the 13 cases,11 cases(84.6%)started with episodic TIA symptoms,and 11 cases(84.6%)had obvious inducing factors related to specific head position changes.Common clinical manifestations included unilateral limb weakness with or without sensory disturbance(10 cases,76.9%),slurred speech(7 cases,53.8%),unilateral limb sensation disorder(4 cases,30.7%),syncope(3 cases,23.1%)and amaurosis(2 cases,15.4%).All 13 cases underwent 64-row head and neck CTA examination,and 6 cases(46.2%)dynamically observed the changes in blood flow velocity through examinations such as transcranial Doppler ultrasound(TCD),cervical vascular ultrasound,and digital subtraction angiography(DSA).All patients were followed up for more than 3 months;and 10 cases(76.9%)achieved clinical cure after treatment,of which 8 cases underwent styloid process shortening surgery;3 cases(23.1%)achieved clinical symptom improvement after treatment.Conclusions For patients with recurrent TIA and/or cerebral infarction,it is necessary to identify whether there are inducing factors related to specific body position changes.For patients highly suspected of SCS,routine examinations such as styloid process CT and 64-row head and neck CTA should be performed,and if necessary,whole brain DSA,dynamic TCD and/or carotid ultrasound should be conducted to guide the diagnosis and treatment.When non-surgical treatment is ineffective,radical styloid process truncation can be considered as a treatment option.