Department of Neurology, Hospital of Memmingen, Memmingen, Germany.
Int J Stroke. 2015 Apr;10(3):360-3. doi: 10.1111/j.1747-4949.2012.00954.x. Epub 2012 Dec 11.
Stroke in patients with acute cervical artery dissection may be anticipated by initial transient ischemic or nonischemic symptoms.
Identifying risk factors for delayed stroke upon cervical artery dissection.
Cervical artery dissection patients from the multicenter Cervical Artery Dissection and Ischemic Stroke Patients study were classified as patients without stroke (n = 339), with stroke preceded by nonstroke symptoms (delayed stroke, n = 244), and with stroke at onset (n = 382). Demographics, clinical, and vascular findings were compared between the three groups.
Patients with delayed stroke were more likely to present with occlusive cervical artery dissection (P < 0.001), multiple cervical artery dissection (P = 0.031), and vertebral artery dissection (P < 0.001) than patients without stroke. No differences were observed in age, smoking, arterial hypertension, hypercholesterolemia, migraine, body mass index, infections during the last week, and trauma during the last month, but patients with delayed stroke had less often transient ischemic attack (P < 0.001) and local signs (Horner syndrome and cranial nerve palsy; P < 0.001).
Occlusive cervical artery dissection, multiple cervical artery dissection, and vertebral artery dissection were associated with an increased risk for delayed stroke. No other risk factors for delayed stroke were identified. Immediate cervical imaging of cervical artery dissection patients without ischemic stroke is needed to identify patients at increased risk for delayed ischemia.
急性颈内动脉夹层患者可能会出现初始短暂性缺血或非缺血性症状，进而引发卒中。
确定颈内动脉夹层延迟性卒中的危险因素。
多中心颈内动脉夹层和缺血性卒中患者研究中的颈内动脉夹层患者分为未发生卒中患者（n=339）、非卒中介导性症状后发生卒中患者（延迟性卒中，n=244）和起病即发生卒中患者（n=382）。比较三组患者的人口统计学、临床和血管特征。
与未发生卒中的患者相比，延迟性卒中患者更易出现闭塞性颈内动脉夹层（P＜0.001）、多发性颈内动脉夹层（P=0.031）和椎动脉夹层（P＜0.001）。两组患者在年龄、吸烟、动脉高血压、高胆固醇血症、偏头痛、体质指数、发病前一周的感染和发病前一个月的创伤方面无差异，但延迟性卒中患者更易出现短暂性脑缺血发作（TIA）（P＜0.001）和局部体征（霍纳综合征和颅神经麻痹；P＜0.001）。
闭塞性颈内动脉夹层、多发性颈内动脉夹层和椎动脉夹层与延迟性卒中风险增加相关。未发现其他延迟性卒中的危险因素。对无缺血性卒中的颈内动脉夹层患者立即进行颈椎成像，以识别存在延迟性缺血风险的患者。
