Thomas Lucy C, Rivett Darren A, Attia John R, Levi Christopher
School of Health Sciences, The University of Newcastle, Callaghan, Australia.
J Orthop Sports Phys Ther. 2015 Jul;45(7):503-11. doi: 10.2519/jospt.2015.5877. Epub 2015 May 21.
Cross-sectional case-control study.
To identify risk factors and clinical presentation of individuals with cervical arterial dissection.
Cervical arterial dissection is a common cause of stroke in young people and has in rare cases been associated with cervical manipulative therapy. The mechanism is considered to involve pre-existing arterial susceptibility and a precipitating event, such as minor trauma. Identification of individuals at risk or early recognition of a dissection in progress could help expedite medical intervention and avoid inappropriate treatment.
Participants were individuals 55 years of age or younger from the Hunter region of New South Wales, Australia with radiologically confirmed vertebral or internal carotid artery dissection and an age- and sex-matched comparison group. Participants were interviewed about risk factors, preceding events, and clinical features of their stroke. Physical examination of joint mobility and soft tissue compliance was undertaken.
Twenty-four participants with cervical arterial dissection and 21 matched comparisons with ischemic stroke but not dissection were included in the study. Seventeen (71%) of the 24 participants with dissection reported a recent history of minor mechanical neck trauma or strain, with 4 of these 17 reporting recent neck manipulative therapy treatment. Cardiovascular risk factors were uncommon, with the exception of diagnosed migraine. Among the participants with dissection, 67% reported transient ischemic features in the month prior to their admission for dissection.
Recent minor mechanical trauma or strain to the head or neck appears to be associated with cervical arterial dissection. General cardiovascular risk factors, with the exception of migraine, were not important risk factors for dissection in this cohort. Preceding transient neurological symptoms appear to occur commonly and may assist in the identification of this serious pathology.
Prognosis, level 4.
横断面病例对照研究。
确定颈内动脉夹层患者的危险因素及临床表现。
颈内动脉夹层是年轻人中风的常见原因，在极少数情况下与颈部手法治疗有关。其机制被认为涉及预先存在的动脉易感性和诱发事件，如轻微创伤。识别高危个体或早期识别正在发生的夹层有助于加快医疗干预并避免不适当的治疗。
参与者为来自澳大利亚新南威尔士州亨特地区55岁及以下经影像学证实有椎动脉或颈内动脉夹层的个体，以及年龄和性别匹配的对照组。对参与者进行了关于危险因素、先前事件及其中风临床特征的访谈。进行了关节活动度和软组织顺应性的体格检查。
本研究纳入了24例颈内动脉夹层患者以及21例匹配的缺血性中风但无夹层的对照者。24例夹层患者中有17例（71%）报告近期有轻微机械性颈部创伤或劳损史，其中这17例中有4例报告近期接受过颈部手法治疗。除已诊断的偏头痛外，心血管危险因素并不常见。在夹层患者中，67%报告在因夹层入院前一个月有短暂性缺血症状。
近期头部或颈部的轻微机械性创伤或劳损似乎与颈内动脉夹层有关。除偏头痛外，一般心血管危险因素在该队列中并非夹层的重要危险因素。先前的短暂性神经症状似乎很常见，可能有助于识别这种严重疾病。
预后，4级。
