椎动脉夹层六例临床诊断和预后VIP免费

·816·生堡控丝型塞蠢!堂生!!旦筮兰!鲞筮!!期要!也』盟丝咝，堕!畦壁!Q堡，!堕：堡!：丛生12椎动脉夹层六例临床诊断和预后李志立黄一宁【摘要】目的探讨椎动脉夹层的临床特点、诊断、治疗和预后。方法6例表现为急性后循环障碍导致脑缺血的患者，经询问病史、体检、常规检查及DSA、MRI、MRA及颈部血管超声等检查，总结临床上椎动脉夹层的诊疗过程。结果起病时有突发颈、枕痛者4例，发病时全部伴有眩晕或头晕，临床上2例表现为Walleuberg综合征；3例有明确颈部外伤史；影像学特点：DSA示椎动脉闭塞或狭窄，MRI示壁内血肿，颈部血管超声示残端样血流信号或线样血流，未发现有血管内膜增厚及动脉粥样硬化斑块；6例椎动脉夹层中5例发生在颅外段；平均随诊26个月，经过抗凝治疗。改良的RankinScale评分分别由病初的4⋯442、2,2分提高到随诊时的4、3、2、1、0、1分，经配对秩和检验．差异有统计学意义(Z=一2．07，P=0．038)。结论椎动脉夹层动脉瘤有特殊的临床表现，诊断并不困难，经长期抗凝治疗，血管可以再通，临床预后较好。【关键词】动脉瘤，假性；椎底动脉供血不足；抗凝药；预后Oiulealmanifestationsandoutcomeofvertebralarteryd趣豫嘣蚰：6case8studiesⅡZhi．玩棚m^『GK一，“硌DepartmentofNeurology，theFirstHospitalofPekingUnivemity，Bering100034，ChinaCorrespondingauthor：HUANGYi—ning，Email：npku@yahoacn【Abstract】ObjectiveToassesstheclinicalfeatures，diagnosis，therapyandtheprognosisofvertebralarterydissectionpresentedagischemiecerebralvasculardisense．MethodsClinicalandroutinelaboratoryexaminationswereperformedinallthe6patients．whounderwentbrainDSA。MBI．MRAandcervicalvascularduplexultrasoundexaminations．r11lev缸lfiUedatleastl0f2imagingcriteriausedtodiagnosevertebraldissection．ResultsTherewassuddenneckpainoroccipitalheadachein4oftIle6cages．Vertigoand(or)dizzinesswerethemainonsetsymptomsforallthesubjects．TwocasespresentedWallenbergsyndrome：ThreehadrecenttraumatotheneckDSAshowedocclusionorstenosisofthevertebralartery．MRIshowedancrescent．shapedintramuralhematoma．CervicalVascularduplexultrasoundrevealednormalintima．mediathicknessandnocarotidatherosclemticplaque．anddisplayedsignificantstenosisorocclusionoftheinvolvedvertebralartery．Thedissectionswerefoundintheextracranialsejz，nentofthevertebralarteryin5cases．Thefollowupperiodforallpatientswasapproximately26months．Theanticoagulanttherapywasadministeredtoausubjectsforaperiodrangingfrom9to53months．，11lemodifiedRankinScale(mRS)improvedsignificantlyascomparedtobaselinesinallexceptforonecage，themRswere4，4，4，2，2，2嬲4，3，2，1，0，l(Z=一2．07，P=0．038)．ConclusionsVertebralarterydissectionhasuniquechnicalfeatures．Neuroimngingisusefulinconfirmingthediagnosis．’nleocclusivelesionoftheinvolvedvertebralarteryisreversibleunderlong·termanticoagulanttreatmenL-11leprognosisisrelativelypositive．【Keywords】Aneurysm，false；Vertebrobasilarinsutfieieney；Anticoagulants；Prognosis动脉夹层又称动脉剥离¨J，多由于动脉内膜撕裂引起血液进入动脉壁形成壁内血肿，向血管内生长的颅颈部动脉夹层可以导致管腔狭窄产生脑缺血的症状；向血管外膜生长的夹层可致动脉瘤样扩张，易破裂导致蛛网膜下腔出血。颅颈动脉夹层是青年脑卒中常见的病因，占45岁以下缺血性脑卒中的作者单位：100034北京大学第一医院神经内科(李志立现在河北省人民医院神经内科，050051石家庄)通信作者：黄一宁，Email：npku@yahoo．∞．临床研究．20％，其中以颈动脉系统夹层较多见，椎基底动脉系统夹层相对少见，Schievink【21报道椎基底动脉系统夹层的年发病率在(1．0一1．5)／10万，容易误诊和漏诊，导致严重残疾，甚至有很高的病死率，但是诊断和治疗及时有可能完全治愈。我们报道6例表...