Nakase Taizen, Suzuki Akifumi, Okane Kumiko, Nagata Ken
Department of Stroke Care Unit, Research Institute for Brain and Blood Vessels, Akita, Japan.
No To Shinkei. 2006 Mar;58(3):239-43.
We report a 63-year-old case of the vertebral artery dissection with recurrent brain embolisms. She was admitted to the hospital because she suffered a visual symptom. She was examined by magnetic resonance imaging (MRI) and diagnosed a left vertebral artery (VA) dissection. Digital subtraction angiography (DSA) revealed the string sign on the left VA supporting the evidence of dissection. However, after DSA, multiple brain embolic stroke was occurred. She was treated with anti-platelet drug (sodium ozagrel), then, recanalization of the pseudo-lumen at the dissecting lesion was observed by MRI examination. Anti-platelet medicine (cilostazol) was taken for preventing reattack although the dissecting lesion was not closed. Following 4 weeks, brain embolisms were observed in the posterior circulation system. MRI revealed a dilated pseudo-lumen at the dissecting lesion with recurrent VA. This time, she was treated only with free radical scavenger (edarabone). After the occlusion of the dissected VA was observed, she started to take anti-platelet medicine again. It is generally accepted to use anti-platelet drug or anti-coagulant drug as a treatment of VA dissection causing brain ischemia. However, it should be assessed more carefully in cases showing recanalization of the pseudo-lumen as observed in this case. Surgical treatments should be taken into consideration at the early stage, especially for the cases presenting fragile dissecting lesions. Further study need to decide the effective treatment of the vertebral artery dissection.
我们报告一例63岁椎动脉夹层伴复发性脑栓塞的病例。她因出现视觉症状入院。经磁共振成像（MRI）检查，诊断为左椎动脉（VA）夹层。数字减影血管造影（DSA）显示左椎动脉有串珠征，支持夹层的诊断。然而，DSA检查后发生了多次脑栓塞性卒中。她接受了抗血小板药物（奥扎格雷钠）治疗，随后MRI检查观察到夹层病变处假腔再通。尽管夹层病变未闭合，但为预防再次发作服用了抗血小板药物（西洛他唑）。4周后，在后循环系统观察到脑栓塞。MRI显示夹层病变处假腔扩张，VA复发。这次，她仅接受了自由基清除剂（依达拉奉）治疗。观察到夹层VA闭塞后，她再次开始服用抗血小板药物。一般认为，使用抗血小板药物或抗凝药物治疗导致脑缺血的VA夹层。然而，对于如本病例中观察到假腔再通的情况，应更仔细地评估。早期应考虑手术治疗，尤其是对于夹层病变脆弱的病例。需要进一步研究以确定椎动脉夹层的有效治疗方法。
