Suzuki Ichiro, Nishino Akiko, Nishimura Shinjitsu, Numagami Yoshihiro, Suzuki Hiroyoshi, Utsunomiya Akihiro, Suzuki Shinsuke, Uenohara Hiroshi, Sakurai Yoshiharu
Department of Neurosurgery, Stroke Center, National Hospital Organization Sendai Medical Center, 2-8-8 Miyagino-ku, Sendai 983-8520, Japan.
No To Shinkei. 2005 Jun;57(6):509-15.
Nontraumatic arterial dissection of the anterior cerebral artery (NAD-ACA) is a relatively rare disease entity, although case reports have recently been increased. We treated 6 patients suffering from NAD-ACA from January 1996 to December 2003, and the neuroradiological findings together with the clinical courses were reviewed. There were 3 males and 3 females with a mean age of 57.7-year-old, ranging from 41 to 65. Five patients had a past history of hypertension and one diabetes mellitus. At the onset, all patients presented with clinical manifestations of cerebral ischemia. Among them, all exhibited contralateral hemiparesis with greater weakness of the lower extremity, and two patients exhibited headache. Initial angiography revealed the pearl and string sign in four patients and string sign, tapered occlusion in each one. Follow-up angiographies revealed sequential changes in all patients; four improved and two progressed. Main anatomic site of the lesion was as follows; five in the A2 and one in the A1 portion, in addition, one patient was complicated by saccular aneurysm, one by PCA dissection, and two had with saccular aneurysm contralateral ACA & MCA and VA dissection each other. Four patients were treated conservatively by intravenous administration of argatroban, one by intravenous administration of Dextrane and one by anti-platelet agent in the acute stage. All patients were treated by anti-platelet agents in the chronic stage. Good recovery was achieved in five patients, but one who suffered from severe subarachnoid hemorrhage in the chronic stage died. Our experience suggests that hypertension and/or the succeeding abnormal structural changes in the arterial wall may contribute to the occurrence of this disease. NAD-ACA showing clinical manifestations of cerebral ischemia could result in a relatively good prognosis; however, attention should be paid to patients treated conservatively with a very closed follow-up angiography to prevent a possibility of severe hemorrhage.
非创伤性大脑前动脉夹层（NAD - ACA）是一种相对罕见的疾病实体，尽管近期病例报告有所增加。我们对1996年1月至2003年12月期间收治的6例NAD - ACA患者进行了治疗，并回顾了其神经放射学检查结果及临床病程。患者中男性3例，女性3例，平均年龄57.7岁，年龄范围为41至65岁。5例患者有高血压病史，1例有糖尿病史。发病时，所有患者均表现出脑缺血的临床表现。其中，所有患者均出现对侧偏瘫，下肢无力更明显，2例患者出现头痛。初次血管造影显示4例患者有珠链征，另2例分别出现线样征、逐渐变细的闭塞。随访血管造影显示所有患者均有连续变化；4例病情改善，2例进展。病变的主要解剖部位如下：5例位于A2段，1例位于A1段，此外，1例患者合并囊状动脉瘤，1例合并大脑后动脉夹层，2例分别合并对侧大脑前动脉和大脑中动脉囊状动脉瘤以及椎动脉夹层。4例患者在急性期通过静脉注射阿加曲班进行保守治疗，1例通过静脉注射右旋糖酐治疗，1例在急性期使用抗血小板药物治疗。所有患者在慢性期均接受抗血小板药物治疗。5例患者恢复良好，但1例在慢性期发生严重蛛网膜下腔出血的患者死亡。我们的经验表明，高血压和/或动脉壁随后出现的异常结构变化可能促成该疾病的发生。表现为脑缺血临床表现的NAD - ACA可能导致相对较好的预后；然而，对于接受保守治疗的患者应密切进行血管造影随访，以预防严重出血的可能性。
