Department of Neurosurgery, Tokyo Metropolitan Tama General Hospital, Musashidai, Fuchu City, Tokyo, Japan.
J Neurosurg. 2011 Apr;114(4):1037-44. doi: 10.3171/2010.9.JNS10668. Epub 2010 Oct 15.
Noninvasive neuroimaging techniques are increasingly identifying unruptured intracranial arterial dissections (IADs) at examination for headache or ischemic symptoms. Approximately 3% of cases of aneurysmal subarachnoid hemorrhage (SAH) are caused by IADs in Japan, but the natural history of unruptured IADs is not known.
Clinical data obtained in 190 patients with 206 IADs were retrospectively analyzed on the basis of long-time follow-up of geometry and clinical event. The IADs were divided into an unruptured group and SAH group depending on the patient's clinical status at the initial diagnosis. Day 0 was defined as the day preceding diagnosis of IAD-that is, the day of symptom onset. This was retrospectively determined from the clinical history.
The 206 IADs included 98 unruptured lesions and 108 SAH. In both groups, the vertebral artery was the most frequent site. In the unruptured group, 93 IADs were followed for a mean of 3.44 years. The mean interval between symptom onset (Day 0) and neuroimaging diagnosis was 9.8 days. Subsequent geometry change was seen in 78 (83.9%) of 93 IADs. Major change was almost completed within 2 months, and complete normalization was seen on neuroimaging in 17 (18.3%) of 93 IADs, with the earliest on Day 15. Rupture of the IAD in the unruptured group occurred in only 1 patient on Day 11. In the SAH group, 84 of the 108 patients complained of preceding headache before onset of SAH. In 81 (96.4%) of the 84 patients, SAH occurred on Day 0-3 with the latest on Day 11. In all patients in the unruptured and SAH groups, the latest day of SAH from the onset of preceding headache was Day 11.
Most IADs causing SAH bleed within a few days of occurrence. Most IADs that are unruptured already have little risk for bleeding at diagnosis because of the repair process. Intracranial arterial dissections may be much more common than previously thought, and the majority may occur and heal without symptom manifestation.
非侵入性神经影像学技术在检查头痛或缺血症状时，越来越多地发现未破裂颅内动脉夹层（IAD）。在日本，约 3%的蛛网膜下腔出血（SAH）病例是由 IAD 引起的，但未破裂 IAD 的自然史尚不清楚。
根据对 190 例 206 例 IAD 患者的长期随访，回顾性分析了这些患者的临床资料。根据患者在初始诊断时的临床状况，将 IAD 分为未破裂组和 SAH 组。第 0 天定义为 IAD 诊断前的一天，即症状发作的那一天。这是从临床病史中回顾性确定的。
206 例 IAD 中，未破裂病变 98 例，SAH 108 例。两组中椎动脉均为最常见部位。在未破裂组中，93 例 IAD 平均随访 3.44 年。症状发作（第 0 天）与神经影像学诊断之间的平均间隔为 9.8 天。93 例 IAD 中有 78 例（83.9%）出现随后的几何形态变化。主要变化在 2 个月内几乎完成，17 例（18.3%）IAD 在神经影像学上完全正常，最早在第 15 天。在未破裂组中，仅 1 例患者在第 11 天发生 IAD 破裂。在 SAH 组中，108 例患者中有 84 例在 SAH 发作前有头痛前驱症状。84 例患者中有 81 例（96.4%）在第 0-3 天发生 SAH，最晚在第 11 天。在未破裂组和 SAH 组的所有患者中，从头痛前驱症状发作到发生 SAH 的最晚时间为第 11 天。
大多数导致 SAH 的 IAD 在发生后几天内出血。大多数未破裂的 IAD 在诊断时已经很少有出血的风险，因为已经有修复过程。颅内动脉夹层的发生可能比以前认为的要普遍得多，而且大多数可能在没有症状表现的情况下发生和愈合。
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