伴/不伴动脉粥样硬化自发性椎动脉及基底动脉夹层相关脑梗死的临床特征分析

Clinical characteristics of cerebral infarction associated with spontaneous vertebral artery and basilar artery dissection with or without atherosclerosis

目的探讨伴/不伴动脉粥样硬化(atherosclerosis,AS)自发性椎动脉夹层(spontaneous vertebral artery dissection,sVAD)、基底动脉夹层(spontaneous basilar artery dissection,sBAD)及椎基底动脉夹层(spontaneous vertebral basilar artery dissection,sV-BAD)相关脑梗死患者的临床特征。方法选取2015年1月1日至2021年11月15日北京天坛医院神经病学中心伴/不伴AS的sVAD、sV-BAD和sBAD相关脑梗死患者,收集患者的一般资料和临床资料,分析其临床特征。结果共纳入患者45例,其中男36例、女9例;年龄20~67岁,平均(42.2±12.3)岁。45例患者中sVAD 33例(73.3%)、sV-BAD 5例(11.1%)和sBAD 7例(15.6%);伴AS 12例(26.7%)、不伴AS 33例(73.3%)。与不伴AS组相比,伴AS组年龄较大([56.0±6.7)岁比(37.2±9.7)岁],高血压比例较高(91.7%比24.2%),颈部按摩比例较少(0比42.4%),多发病灶比例较高(90.9%比45.5%),差异均有统计学意义(P<0.05)。伴AS组与不伴AS组出现头痛、枕部疼痛或颈部疼痛到脑梗死发作时间的比较[6.0(0.0,20.0)d比2.0(0.0,15.0)d],差异无统计学意义(P>0.05)。结论不伴AS的sVAD、sV-BAD相关脑梗死患者颈部按摩比较高。sVAD患者发病前出现的头痛、枕部疼痛及颈部疼痛等症状,可能是其脑梗死发生的预警信号。

Objective To explore the clinical characteristics of patients with cerebral infarction associated with spontaneous vertebral artery dissection(sVAD),spontaneous basilar artery dissection(sBAD),and spontaneous vertebral basilar artery dissection(sV-BAD)with or without atherosclerosis(AS).Methods Patients with cerebral infarction associated with sVAD,sBAD and sV-BAD with or without AS admitted to the Department of Neurology,Beijing Tiantan Hospital from January 1st,2015 to November 15th,2021 were selected,and their general data and clinical data were collected to analyze the clinical characteristics.Results A total of 45 patients were selected,including 36 males and nine females.The age ranged from 20 to 67 years with an average of(42.2±12.3)years.Among the 45 patients,thirty-three cases were sVAD(73.3%),five cases were sV-BAD(11.1%)and seven cases were sBAD(15.6%).There were 12 cases with AS(26.7%)and 33 cases without AS(73.3%).Compared with the group without AS,the group with AS was older[(56.0±6.7)years vs.(37.2±9.7)years],with higher proportion of hypertension(91.7%vs.24.2%),less proportion of neck massage(0 vs.42.4%)and higher proportion of multiple lesions(90.9%vs.45.5%),and the differrences were statistically significant(P<0.05).There was no significant difference in the time from from headache,occipital pain and neck pain to cerebral infarction between the group with AS and the group without AS[6.0(0.0,20.0)d vs.2.0(0.0,15.0)d,P>0.05].Conclusions Patients with sVAD、sV-BAD related cerebral infarction without AS have higher proportion of neck massage.Symptoms such as headache,occipital pain and neck pain before the onset of sVAD may be the early warning signals of cerebral infarction.