Bernard Timothy J, Mull Brendan R, Handler Michael H, Harned Roger K, Filley Christopher M, Kumpe David A, Tseng Brian S
Department of Neurology and Pediatrics, The Children's Hospital, 1056 E. 19th Ave. B155, Denver CO 80218, USA.
J Neurol Sci. 2007 Sep 15;260(1-2):279-82. doi: 10.1016/j.jns.2007.04.032. Epub 2007 Jun 12.
Fenestration of vertebral arteries has been reported in association with thromboembolic brain infarctions. However, few cases have been reported in which recurrent infarction occurred in spite of adequate anticoagulation. We report a young man with fenestrated vertebral arteries and stroke who failed to respond to standard anticoagulation therapy but did well with angiographic coil obliteration of an abnormal vertebral segment. An 18-year-old left-handed man presented with acute onset of dizziness and headache. No trauma or other stroke risk factors were identified. Left cerebellar infarction was seen on CT, but the cause could not be identified by brain and neck MRI, MRA, or CTA. Bilateral fenestrated vertebral arteries were identified with conventional angiography. Although the patient recovered fully and was treated with anticoagulation, he suffered a recurrent stroke 1 month later involving the right cerebellum while he was on a therapeutic dose of warfarin. Repeat arteriography showed a spontaneous dissection within one of the fenestrated vertebral segments. Since receiving angiographic coil obliteration of the pathologic segment, he has been free of all symptoms. We conclude that the patient sustained recurrent thromboembolic events in his posterior circulation due to spontaneous dissection within a fenestrated vertebral artery segment. Conventional angiography and emergent interventional embolization were essential to his diagnostic evaluation and therapeutic intervention.
椎动脉开窗畸形已被报道与血栓栓塞性脑梗死有关。然而，尽管进行了充分的抗凝治疗，但仍有复发性梗死的病例报道较少。我们报告了一名患有椎动脉开窗畸形和中风的年轻人，他对标准抗凝治疗无效，但经血管造影线圈闭塞异常椎动脉节段后情况良好。一名18岁的左撇子男性出现急性头晕和头痛。未发现外伤或其他中风危险因素。CT显示左侧小脑梗死，但脑部和颈部MRI、MRA或CTA均无法确定病因。经传统血管造影发现双侧椎动脉开窗畸形。尽管患者完全康复并接受了抗凝治疗，但在服用治疗剂量华法林期间，1个月后他再次中风，累及右侧小脑。重复动脉造影显示其中一个开窗椎动脉节段内有自发性夹层形成。自从对病变节段进行血管造影线圈闭塞治疗后，他已无任何症状。我们得出结论，该患者后循环出现复发性血栓栓塞事件是由于开窗椎动脉节段内的自发性夹层形成。传统血管造影和紧急介入栓塞对其诊断评估和治疗干预至关重要。
