Marshman Laurence A G, Ball Luke, Jadun Changez K
Department of Neurosurgery, North Staffordshire Royal Infirmary, Hartshill, Stoke-on-Trent, Staffordshire ST4 7LN, United Kingdom.
Clin Neurol Neurosurg. 2007 Nov;109(9):816-20. doi: 10.1016/j.clineuro.2007.07.004. Epub 2007 Aug 20.
Spontaneous bilateral carotid and vertebral artery dissections (CADs and VADs) are rare. A 29-year-old female presented with a collapse, 4 weeks after a sudden onset of severe neck and shoulder pain. CT scan revealed diffuse subarachnoid hemorrhage (SAH) and early hydrocephalus. Angiography revealed bilateral CADs and VADs, along with multiple fusiform and saccular aneurysms. Systemic vessels - including the renal arteries - were normal, and no risk factors or underlying vasculopathy were apparent. The presumed source of SAH (a posterior cerebral artery aneurysm) was successfully clipped. Each dissection, by contrast, was managed conservatively with heparin prophylaxis; and spontaneous CAD and VAD resolution occurred within 6 months. We present a unique case of four-vessel dissection associated with multiple disparate saccular and fusiform aneurysms. We suspect that underlying vasculopathy - perhaps novel - may become apparent with time.
自发性双侧颈动脉和椎动脉夹层（CADs和VADs）较为罕见。一名29岁女性在突发严重颈部和肩部疼痛4周后出现意识丧失。CT扫描显示弥漫性蛛网膜下腔出血（SAH）和早期脑积水。血管造影显示双侧CADs和VADs，以及多个梭形和囊状动脉瘤。包括肾动脉在内的全身血管正常，未发现明显的危险因素或潜在血管病变。推测的SAH来源（大脑后动脉动脉瘤）成功夹闭。相比之下，每个夹层均采用肝素预防进行保守治疗；CAD和VAD自发消退在6个月内发生。我们报告了一例独特的四血管夹层病例，伴有多个不同的囊状和梭形动脉瘤。我们怀疑潜在的血管病变——可能是新发现的——可能会随着时间的推移而显现出来。
