Department of Neurology, Basel University Hospital, Basel, Switzerland.
Neurology. 2013 May 21;80(21):1950-7. doi: 10.1212/WNL.0b013e318293e2eb. Epub 2013 May 1.
To examine the import of prior cervical trauma (PCT) in patients with cervical artery dissection (CeAD).
In this observational study, the presence of and the type of PCT were systematically ascertained in CeAD patients using 2 different populations for comparisons: 1) age- and sex-matched patients with ischemic stroke attributable to a cause other than CeAD (non-CeAD-IS), and 2) healthy subjects participating in the Cervical Artery Dissection and Ischemic Stroke Patients Study. The presence of PCT within 1 month was assessed using a standardized questionnaire. Crude odds ratios (ORs) with 95% confidence intervals (CIs) and ORs adjusted for age, sex, and center were calculated.
We analyzed 1,897 participants (n = 966 with CeAD, n = 651 with non-CeAD-IS, n = 280 healthy subjects). CeAD patients had PCT in 40.5% (38.2%-44.5%) of cases, with 88% (344 of 392) classified as mild. PCT was more common in CeAD patients than in non-CeAD-IS patients (ORcrude 5.6 [95% CI 4.20-7.37], p < 0.001; ORadjusted 7.6 [95% CI 5.60-10.20], p < 0.001) or healthy subjects (ORcrude 2.8 [95% CI 2.03-3.68], p < 0.001; ORadjusted 3.7 [95% CI 2.40-5.56], p < 0.001). CeAD patients with PCT were younger and presented more often with neck pain and less often with stroke than CeAD patients without PCT. PCT was not associated with functional 3-month outcome after adjustment for age, sex, and stroke severity.
PCT seems to be an important environmental determinant of CeAD, but was not an independent outcome predictor. Because of the characteristics of most PCTs, the term mechanical trigger event rather than trauma may be more appropriate.
探讨先前颈椎创伤（PCT）在颈内动脉夹层（CeAD）患者中的意义。
在这项观察性研究中，使用两种不同的人群进行比较，系统地确定 CeAD 患者 PCT 的存在和类型：1）年龄和性别匹配的因 CeAD 以外的原因导致缺血性卒中的患者（非 CeAD-IS），2）参加颈内动脉夹层和缺血性卒中患者研究的健康受试者。使用标准化问卷评估 PCT 在 1 个月内的存在情况。计算粗比值比（OR）及其 95%置信区间（CI）和调整年龄、性别和中心的 OR。
我们分析了 1897 名参与者（n = 966 名 CeAD 患者，n = 651 名非 CeAD-IS 患者，n = 280 名健康受试者）。CeAD 患者 PCT 的发生率为 40.5%（38.2%-44.5%），其中 88%（344/392）为轻度。与非 CeAD-IS 患者（OR 粗率 5.6[95%CI 4.20-7.37]，p<0.001；OR 调整后 7.6[95%CI 5.60-10.20]，p<0.001）或健康受试者（OR 粗率 2.8[95%CI 2.03-3.68]，p<0.001；OR 调整后 3.7[95%CI 2.40-5.56]，p<0.001）相比，CeAD 患者 PCT 更为常见。患有 PCT 的 CeAD 患者比没有 PCT 的 CeAD 患者更年轻，更常出现颈部疼痛，而较少出现卒中。在校正年龄、性别和卒中严重程度后，PCT 与 3 个月后的功能结局无关。
PCT 似乎是 CeAD 的一个重要环境决定因素，但不是独立的预后预测因素。由于大多数 PCT 的特征，术语机械触发事件而不是创伤可能更为合适。
