CAJ | 학술논문

目的分析椎动脉夹层致青年脑卒中的临床表现和影像学特征,并探讨其治疗与转归. 方法回顾性分析烟台山医院和毓璜顶医院神经内科自2008年1月至2011年12月住院的9例诊断明确的椎动脉夹层致青年脑卒中患者的病史资料和影像学检查,总结抗凝治疗后3个月、6个月和12个月椎动脉夹层的血管再通情况. 结果 9例患者均表现为头晕或眩晕,其中5例有颈部剧烈活动诱因,7例起病时有枕部或后颈部疼痛；颅脑MRI多有小脑、脑干梗死或延髓背外侧综合征表现；DSA检查发现均为椎动脉夹层(V3段为主),其中5例为线样征或鼠尾征,1例双腔征,2例夹层闭塞,1例瘤样扩张.瘤样扩张患者直接行支架治疗,另8例患者经抗凝治疗后3个月、6个月和12个月复查DSA显示:3个月时4例再通,6个月时6例再通,12个月时仍为6例再通,余未通者行血管内支架介入治疗.平均随访18个月,患者均无脑卒中复发. 结论临床上部分椎动脉夹层致青年脑卒中患者仅表现为枕部或后颈部疼痛不适,及时行脑血管检查对明确诊断至关重要；内科规范抗凝治疗可以缓解患者临床症状和改善血管状况;血管再通主要发生在抗凝治疗后6个月以内.
목적 분석추동맥협층치청년뇌졸중적림상표현화영상학특정,병탐토기치료여전귀. 방법 회고성분석연태산의원화육황정의원신경내과자2008년1월지2011년12월주원적9례진단명학적추동맥협층치청년뇌졸중환자적병사자료화영상학검사,총결항응치료후3개월、6개월화12개월추동맥협층적혈관재통정황. 결과 9례환자균표현위두훈혹현훈,기중5례유경부극렬활동유인,7례기병시유침부혹후경부동통；로뇌MRI다유소뇌、뇌간경사혹연수배외측종합정표현；DSA검사발현균위추동맥협층(V3단위주),기중5례위선양정혹서미정,1례쌍강정,2례협층폐새,1례류양확장.류양확장환자직접행지가치료,령8례환자경항응치료후3개월、6개월화12개월복사DSA현시:3개월시4례재통,6개월시6례재통,12개월시잉위6례재통,여미통자행혈관내지가개입치료.평균수방18개월,환자균무뇌졸중복발. 결론 림상상부분추동맥협층치청년뇌졸중환자부표현위침부혹후경부동통불괄,급시행뇌혈관검사대명학진단지관중요；내과규범항응치료가이완해환자림상증상화개선혈관상황;혈관재통주요발생재항응치료후6개월이내.
Objective To analyze the clinical and radiological features of young stroke caused by vertebral artery dissection to discuss its therapy and outcome.Methods Nine patients with confirmed diagnosis of young stroke caused by vertebral artery dissection,admitted to our hospitals from January 2008 to December 2011,were chosen in our study; their history data and radiological features were retrospectively analyzed,and DSA presentations were summarized at 3,6,and 12 months after anticoagulant therapy.Results Nine patients all had diziness or vertigo,including five patients having inducement of acute neck activity and seven patients having occipital or posterior cervical pain.Most patients manifested cerebellum or brainstem infarction or Wallenberg syndrome in MRI.All patients had vertebral artery dissection (V3 segnent primarily),including five patients with string sign or rat tail sign,one patient with double cavity sign,two patients with vertebral occlusion and the last one patient with aneurysm expansion.Among 9 patients,the one with aneurysm expansion was directly treated with stent,the other 8 patients were treated with anticoagulant drug; DSA was performed at 3,6,and 12 months,and the rate of complete recanalization was 50％ (4/8) at 3 months,75％ (6/8) at 6 months and 75％(6/8) at 12 months; the patients without recanalization were then treated with stent.The average follow-up was 18 months without noting stroke recurrences.Conclusions Young stroke induced by vertebral artery dissection often merely manifests occipital or posterior cervical pain; cerebrovascular detection is very important to the diagnosis.Standard anticoagulant therapy can alleviate clinical symptoms and improve blood vessel status,and recanalization of vertebral artery dissection occurs mainly within the first 6 months of anticoagulant therapy.