Aries M J H, De Jong B M, Uyttenboogaart M, Regtien J G, van der Naalt J
Department of Neurology and Critical Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
Clin Neurol Neurosurg. 2010 Oct;112(8):691-4. doi: 10.1016/j.clineuro.2010.05.015. Epub 2010 Jun 26.
Traumatic cervical artery dissection (TCAD) is a relative infrequent complication of traumatic brain injury (TBI). Since TCAD is associated with morbidity in a considerable percentage of patients, it is important to obtain clues for recognising TCAD in this category of patients.
Retrospective case-cohort study in severe TBI patients.
Five patients with traumatic cervical artery dissection after severe TBI, leading to ischemic strokes, are described. Secondary deterioration to coma was present in four out of five patients during admission. The diagnosis of TCAD was delayed in most cases because the secondary deterioration was often attributed to multisystem problems related to trauma patients, i.e. shock or hypoxia or medication effects. Local clinical symptoms and signs suggestive of TCAD are difficult to detect in this patient group. In all patients, the CT-scan on admission demonstrated no abnormalities. A follow-up scan at day 2 revealed that in all patients abnormalities in the vascular territories had evolved.
With this case-cohort study we underline the importance of considering TCAD in severe TBI patients and emphasise the role for standard follow-up brain imaging. Also possible treatment consequences are discussed.
创伤性颈内动脉夹层（TCAD）是创伤性脑损伤（TBI）相对少见的并发症。由于相当一部分患者的TCAD会导致发病，因此在这类患者中获取识别TCAD的线索很重要。
对重度TBI患者进行回顾性病例队列研究。
描述了5例重度TBI后发生创伤性颈内动脉夹层并导致缺血性卒中的患者。5例患者中有4例在入院期间继发昏迷。大多数情况下TCAD的诊断被延迟，因为继发恶化通常归因于与创伤患者相关的多系统问题，即休克、缺氧或药物作用。在该患者群体中，难以检测到提示TCAD的局部临床症状和体征。所有患者入院时的CT扫描均未显示异常。第2天的随访扫描显示，所有患者血管区域均出现了异常。
通过本病例队列研究，我们强调了在重度TBI患者中考虑TCAD的重要性，并强调了标准随访脑成像的作用。还讨论了可能的治疗后果。
