Baumgartner R W, Arnold M, Baumgartner I, Mosso M, Gönner F, Studer A, Schroth G, Schuknecht B, Sturzenegger M
Department of Neurology, University Hospital Zurich, Switzerland.
Neurology. 2001 Sep 11;57(5):827-32. doi: 10.1212/wnl.57.5.827.
To study whether spontaneous dissections of the cervical internal carotid artery dissection (ICAD) with and without ischemia of the brain or retina differ in the prevalence of vascular risk factors, local neurologic signs and symptoms, and stenoses and occlusions of the cerebral arteries.
The authors prospectively studied 181 consecutive patients with 200 ICAD. Diagnosis was based on ultrasonography and MRI or catheter angiography. Vascular risk factors, presenting local (headache, neck pain, Horner syndrome, pulsatile tinnitus, cranial nerve palsy on the side of the ICAD) and ischemic signs and symptoms, and ultrasonographic findings in the carotid and basal cerebral arteries were evaluated.
ICAD with ischemic events (n = 145) had a higher prevalence of hypercholesterolemia (p < 0.05), >80% stenoses and occlusions of the ICA (p < 0.0001), and intracranial obstructions (p < 0.001). ICAD without ischemic events (n = 55) had a higher prevalence of Horner syndrome (p < 0.001), cranial nerve palsy (p < 0.01), and normal ICA findings (p < 0.0001).
These data suggest that ICAD causing high-grade stenosis and occlusion are more likely to lead to intracranial obstructions and cerebral or retinal ischemic events. Conversely, ICAD without luminal narrowing cause more local signs and symptoms.
研究伴有或不伴有脑或视网膜缺血的颈内动脉夹层（ICAD）自发性夹层在血管危险因素、局部神经系统体征和症状以及脑动脉狭窄和闭塞的患病率方面是否存在差异。
作者前瞻性研究了181例连续的患者，共200处ICAD。诊断基于超声检查、MRI或导管血管造影。评估血管危险因素、出现的局部（头痛、颈部疼痛、霍纳综合征、搏动性耳鸣、ICAD侧的脑神经麻痹）和缺血性体征及症状，以及颈动脉和基底脑动脉的超声检查结果。
伴有缺血事件的ICAD（n = 145）高胆固醇血症的患病率更高（p < 0.05），颈内动脉（ICA）狭窄和闭塞>80%的患病率更高（p < 0.0001），颅内梗阻的患病率更高（p < 0.001）。不伴有缺血事件的ICAD（n = 55）霍纳综合征的患病率更高（p < 0.001），脑神经麻痹的患病率更高（p < 0.01），ICA正常表现的患病率更高（p < 0.0001）。
这些数据表明，导致高度狭窄和闭塞的ICAD更有可能导致颅内梗阻以及脑或视网膜缺血事件。相反，无管腔狭窄的ICAD会引起更多局部体征和症状。
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