Oomura Masahiro, Terai Tadashi, Shigeno Koji
Department of Neurology, Shizuoka Municipal Shimizu Hospital.
Rinsho Shinkeigaku. 2006 Feb;46(2):160-2.
A 57-year-old woman had noticed occipital headache and neck pain bilaterally 6 weeks before admission. The headache and neck pain persisted for 3 weeks, then disappeared. Cranial magnetic resonance (MR) image obtained 4 weeks after the onset demonstrated intramural hematoma adjacent to intracranial left vertebral artery. MR image did not show any abnormal lesions in the brain parenchyma. Although cranial MR angiography did not show any definite aneurysms, three-dimensional CT angiography (3D-CTA) obtained 6 weeks after the onset disclosed an aneurysm of the left vertebral artery. The vessel distal to the aneurysm was occluded. Because the left posterior inferior cerebellar artery originated from the aneurysm, we did not perform embolization using coils. Spontaneous dissecting aneurysm of the left vertebral artery was diagnosed based on the clinical, MR image, and 3D-CTA findings. The systolic blood pressure was maintained under 130 mmHg using antihypertensive agents. Thereafter, 3D-CTA obtained 6 months after the onset showed recanalization of the occluded vessel distal to the aneurysm. The size of the aneurysm was unchanged. During these 6 months, there were no ischemic or hemorrhagic stroke events. In the present patient, headache and neck pain were the only manifestations of spontaneous dissection of the vertebral artery.
一名57岁女性在入院前6周双侧出现枕部头痛和颈部疼痛。头痛和颈部疼痛持续了3周，然后消失。发病4周后进行的头颅磁共振（MR）成像显示颅内左椎动脉旁壁内血肿。MR图像未显示脑实质内有任何异常病变。尽管头颅MR血管造影未显示任何明确的动脉瘤，但发病6周后进行的三维CT血管造影（3D-CTA）显示左椎动脉有一个动脉瘤。动脉瘤远端的血管闭塞。由于左小脑后下动脉起源于动脉瘤，我们未使用弹簧圈进行栓塞。根据临床、MR图像和3D-CTA检查结果，诊断为左椎动脉自发性夹层动脉瘤。使用抗高血压药物将收缩压维持在130 mmHg以下。此后，发病6个月后进行的3D-CTA显示动脉瘤远端闭塞血管再通。动脉瘤大小未变。在这6个月期间，没有发生缺血性或出血性中风事件。在本患者中，头痛和颈部疼痛是椎动脉自发性夹层的唯一表现。
