椎动脉夹层致脑梗死4例病例报道并文献复习

Cerebral Infarction Caused by Vertebral Artery Dissection(Report of 4 Cases and Literature Review)

目的:分析椎动脉夹层(VAD)的临床特点,探讨其与脑梗死的关系。方法:回顾性分析4例VAD致脑梗死患者的临床资料,并结合文献复习。结果:本组4例VAD患者中,2例患者有高血压病史,1例有高血压病相关家族史,1例无相关病史或家族史;3例患者有10年以上的吸烟史;4例患者均表现为头晕、恶心呕吐、行走不稳等后循环缺血症状,其中2例有显著的头枕部痛;4例患者均经DSA确诊为VAD。3例患者行抗血小板药物治疗,1例行血管内介入治疗。3例患者康复出院;1例治疗后仍有显著的头枕部痛症状,拒绝进一步治疗予出院。结论:脑梗死患者有高血压病及长期吸烟史,表现为头晕、头枕痛等后循环缺血症状,应考虑VAD的可能。DSA是目前诊断VAD的金标准,及时规范的治疗可改善VAD患者的预后。

Objective: To analyze the clinical characteristics of vertebral artery dissection(VAD), and investigate the relationship between VAD and cerebral infarction. Methods: The clinical data of 4 cases of cerebral infarction caused by VAD were retrospectively analyzed and the relative literature were reviewed. Results: Among 4 cases, 2 cases had hypertension,1 had family history of hypertension and 1 had no relative condition. 3 cases had been smoking for more than 10 years. All cases mainly presented with symptoms of posterior circulation ischemia and 2 had serious occipital headache. 4 cases were all diagnosed by DSA. 3 cases were treated with antiplatelet drugs and 1 case was treated with intravascular interventional therapy. 3 cases recovered and 1 case with occipital headache refused further treatment. Conclusions: Cerebral infarction patients with history of hypertension and smoking,presented with symptoms of posterior circulation ischemia may have VAD and DSA is currently the gold standard for its diagnosis.