Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France; Inserm U897, Bordeaux University, France.
Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands.
Lancet Neurol. 2015 Jun;14(6):640-54. doi: 10.1016/S1474-4422(15)00009-5.
Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defined by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass effect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be difficult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confirm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without.
自发性颅内动脉夹层是一种不常见且可能诊断不足的卒中病因，其定义为颅内动脉壁出现血肿。患者可表现为头痛、缺血性卒中、蛛网膜下腔出血，或有与占位效应相关的症状，主要发生在脑干。尽管在欧洲裔成年人中，颅内动脉夹层比颈内动脉夹层少见，但据报道，在儿童和亚洲人群中，颅内动脉夹层更为常见。风险因素和发病机制尚不清楚，诊断具有挑战性，因为鉴于颅内动脉较小，特征性的影像学特征可能难以检测。因此，通常需要进行多模态随访成像以确认诊断。由于缺乏来自随机对照试验的数据，颅内动脉夹层的治疗是经验性的。大多数蛛网膜下腔出血患者接受手术或血管内治疗以防止再出血，而颅内动脉夹层和脑缺血患者则接受抗血栓治疗。蛛网膜下腔出血患者的预后似乎比无蛛网膜下腔出血患者差。
