Division of Neurology, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy.
Neurol Sci. 2010 Jun;31 Suppl 1:S123-5. doi: 10.1007/s10072-010-0303-8.
Dissection of epiaortic vessels is a rare event but can have serious clinical consequences such as ischaemic injury to the brain, cerebellum or, more rarely to the retina and is an important cause of stroke in young adults. The main clinical presentation is headache or neck pain, usually but not always associated with Horner syndrome or other local symptoms, followed by an ischemic event in the carotid or vertebral district. Very rarely, the dissection can extend to the intracranial vessels leading to subarachnoid hemorrhage. The time between the headache and the stroke is variable, ranging from a few seconds to weeks. Suspecting an arterial dissection in cases of unexplained head or neck pain in young patients is than crucial to avoid cerebrovascular events; the clinical suspect must be confirmed by ultrasound examination of the epiaortic vessels as a first screening exam, followed by an appropriate neuroimaging study. Treatment with anticoagulants, although not supported by randomized trials, is generally employed to prevent embolic events. The prognosis of stroke caused by arterial dissection does not differ from that of ischaemic events of other origin; the rate of recurrence is low and most patients have only one event in their live. Clinical research with multicenter recruitment is ongoing to provide more solid evidence on the management and prognosis of arterial dissections.
主动脉外膜血管解剖是一种罕见的事件，但可能会产生严重的临床后果，如脑、小脑缺血损伤，或更罕见的视网膜损伤，是年轻人中风的一个重要原因。主要临床表现为头痛或颈部疼痛，通常但不总是伴有霍纳综合征或其他局部症状，随后发生颈动脉或椎动脉区域的缺血事件。非常罕见的情况下，夹层可能延伸至颅内血管，导致蛛网膜下腔出血。头痛和中风之间的时间是可变的，从几秒钟到几周不等。在年轻患者出现不明原因的头部或颈部疼痛时，怀疑动脉夹层是至关重要的，以避免脑血管事件；临床怀疑必须通过主动脉外膜血管超声检查来确认，作为第一个筛选检查，然后进行适当的神经影像学研究。尽管没有随机试验支持，但通常使用抗凝剂治疗，以预防栓塞事件。动脉夹层引起的中风的预后与其他来源的缺血事件的预后没有区别；复发率低，大多数患者在其一生中只有一次事件。正在进行多中心招募的临床研究，以提供关于动脉夹层的管理和预后的更可靠证据。
