Faculty of Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia.
BMC Musculoskelet Disord. 2012 Sep 3;13:164. doi: 10.1186/1471-2474-13-164.
Craniocervical arterial dissection is a major cause of ischaemic stroke in young adults. The pathogenesis is not fully understood but is thought to be related to a combination of an intrinsic weakness in the arterial wall and an external trigger. Intrinsic susceptibility is thought to be a generalised arteriopathy, vascular anomaly or genetic predisposition. Proposed extrinsic factors include recent viral infection and minor mechanical trauma to the neck, including neck manipulation, which has raised concerns amongst manual practitioners in particular as to the appropriate screening of patients and avoidance of more vigorous therapeutic techniques. The presenting features of dissection may mimic a musculoskeletal presentation, creating a diagnostic dilemma for primary care practitioners. Early recognition is critical so that appropriate management can be commenced.The aims of this study are to prospectively investigate young patients ≤55 years admitted to hospital with radiologically diagnosed craniocervical arterial dissection compared to matched controls with stroke but not dissection, to identify risk factors and early presenting clinical features, so these may be more readily identified by primary care practitioners.
Patients ≤ 55 years presenting to hospital with craniocervical arterial dissection and controls will have their medical records reviewed and be interviewed and questioned about possible risk factors, preceding events to admission such as recent neck trauma, and presenting clinical features including any preceding transient ischaemic features. Clinical assessment will include a connective tissue screening examination to identify subclinical connective tissue disorders. Radiology and blood screening will be reviewed for typical features and inflammatory markers. Functional outcome will be reviewed to determine the burden of the stroke.
This study will provide descriptive and comparative data on intrinsic and extrinsic risk factors for craniocervical arterial dissection and outline the typical clinical presentation, including the nature of early presenting features which might assist practitioners to identify those patients for whom vigorous manual therapy of the neck is inappropriate and alert them to those for whom immediate urgent medical care should be sought.
颅颈动脉夹层是年轻成年人缺血性脑卒中的主要原因。其发病机制尚未完全阐明，但被认为与动脉壁的内在弱点和外部触发因素有关。内在易感性被认为是一种全身性的血管病、血管异常或遗传易感性。提出的外在因素包括近期病毒感染和颈部的轻微机械创伤，包括颈部操作，这引起了特别是手法治疗师对患者进行适当筛查和避免更剧烈治疗技术的关注。夹层的表现可能类似于肌肉骨骼表现，给初级保健医生带来了诊断上的困境。早期识别至关重要，以便开始适当的治疗。本研究的目的是前瞻性研究因放射学诊断为颅颈动脉夹层而住院的≤55 岁年轻患者，并与无夹层但有脑卒中的匹配对照组进行比较，以确定危险因素和早期表现的临床特征，以便初级保健医生更容易识别这些特征。
≤55 岁因颅颈动脉夹层而到医院就诊的患者和对照组将对其病历进行回顾，并对其进行访谈和询问可能的危险因素、入院前的事件，如近期颈部创伤，以及表现出的临床特征，包括任何先前短暂性缺血特征。临床评估将包括结缔组织筛查检查，以确定亚临床结缔组织疾病。将对放射学和血液检查结果进行回顾，以寻找典型特征和炎症标志物。将对功能结果进行回顾，以确定脑卒中的负担。
本研究将提供颅颈动脉夹层的内在和外在危险因素的描述性和对比数据，并概述典型的临床表现，包括早期表现的性质，这些表现可能有助于医生识别那些不适合剧烈颈部手法治疗的患者，并提醒他们那些需要立即紧急医疗护理的患者。
