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目的:总结椎动脉夹层所致疾病的临床特点。方法:对16例经全脑数字减影血管造影(DSA)或CT血管造影(CTA)证实的椎动脉夹层患者的临床资料进行分析。结果:16例患者均通过DSA诊断椎动脉夹层。其中临床表现为头痛者12例,其中枕部疼痛者7例;颈部疼痛者3例,其中颈强直2例;Wallenberg综合征9例,其中不全表现者6例;恶心呕吐9例;头晕8例;行走不稳4例。影像经DSA检查本组呈“串珠”征者15例;“双腔”征1例。诊断脑干梗死7例,其中延髓梗死6例;蛛网膜下腔出血3例;颅内未见病变6例。6例采取内科治疗,症状好转未再复发;9例采用介入治疗,术后均有不同程度好转,3个月至12个月复查未见复发。其中1例载瘤动脉闭塞者,术后即出现Wallenberg综合征,MRI提示延髓梗死,考虑影响小脑后下动脉(PICA)所致,予内科治疗后好转。结论:椎动脉夹层是引起后循环缺血及蛛网膜下腔出血的原因之一,临床多表现为头痛、颈痛、头晕及局部神经功能缺损症状,其中以颈、枕部痛者多见。在DSA及CTA中主要表现为:“串珠”征;“线样”征;“玫瑰花”征;“双腔”征;也可形成假性动脉瘤或者完全闭塞。以“串珠”征多见。正确识别临床征像积极进一步检查明确诊断,并及时给予必要的治疗对于改善患者预后至关重要。
Objective: To summarize the clinical features of diseases caused by vertebral artery dissection. Methods: Clinical data of 16 patients with vertebral artery dissection confirmed by whole-brain digital subtraction angiography (DSA) or CT angiography (CTA) were analyzed. Results: All 16 patients were diagnosed as vertebral artery dissection by DSA. The clinical manifestations of headache in 12 cases, of which 7 cases of occipital pain; neck pain in 3 cases, including 2 cases of neck stiffness; Wallenberg syndrome in 9 cases, 6 cases of incomplete performance in these cases; 9 cases of nausea and vomiting; dizziness 8 Cases; walking instability in 4 cases. Image by DSA examination of the group was “beaded” sign in 15 cases; “double lumen” sign in 1 case. Diagnosis of brain stem infarction in 7 cases, including 6 cases of medullary infarction; 3 cases of subarachnoid hemorrhage; no intracranial lesions in 6 cases. 6 cases took medical treatment, the symptoms improved no recurrence; 9 cases were treated with interventional treatment after all, varying degrees of improvement, 3 months to 12 months, no recurrence of the review. Among them, 1 had tumor-bearing artery occlusion, and Wallenberg’s syndrome appeared after operation. MRI showed that the infarction of the medulla oblongata was caused by the influence of the posterior inferior cerebellar artery (PICA), which improved after the medical treatment. Conclusions: Vertebral artery dissection is one of the causes of posterior circulation ischemia and subarachnoid hemorrhage. Clinical manifestations include headache, neck pain, dizziness and local neurological deficits. Among them, neck and occipital pain are more common. Mainly in the DSA and CTA: “beaded ” sign; “line style ” sign; “rose ” sign; “double chamber ” sign; also can form pseudoaneurysm or completely occluded . To “beaded ” sign more common. Correctly identify the clinical signs of positive further examination of a clear diagnosis, and promptly give the necessary treatment for improving the prognosis of patients is essential.