Shanmugalingam Renuka, Reza Pour Nina, Chuah Siang Chye, Vo Thi Mong, Beran Roy, Hennessy Annemarie, Makris Angela
Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia.
Western Sydney University, Penrith, Australia.
BMC Pregnancy Childbirth. 2016 Jul 16;16(1):164. doi: 10.1186/s12884-016-0953-5.
Arterial dissection is a rare complication of pregnancy and puerperium. There have been reports of aortic, coronary and cervical artery dissection in association with preeclampsia, however, vertebral artery dissection is rarely reported particularly in the antenatal setting in the presence of a Hypertensive Disorder of Pregnancy (HDP).The general annual incidence of symptomatic spontaneous cervicocephalic arterial dissection is 0.0026 % and a data registry reported that 2.4 % of these occurred in the post-partum period. The actual incidence of vertebral artery dissection in HDP is unknown as the current literature consists of case series and reports only with most documenting adverse outcomes. Given the presence of collateral circulation, unilateral vertebral artery dissections may go unrecognised and may be more common than suspected.
We present a case series of four patients with vertebral artery dissection in association with HDP, two of which occurred in the antenatal setting and two in the post-partum setting. All our patients had favourable outcome with no maternal neurological deficit and live infants. Our discussion covers the proposed pathophysiology of vertebral artery dissection in HDP and the management of it.
Our case series highlights the need to consider VAD an important differential diagnosis when assessing pregnant women with headache and neck pain particularly in the context of HDP.
动脉夹层是妊娠和产褥期罕见的并发症。有报道称主动脉、冠状动脉和颈内动脉夹层与子痫前期有关，然而，椎动脉夹层很少被报道，尤其是在存在妊娠高血压疾病（HDP）的产前情况下。有症状的自发性头颈部动脉夹层的总体年发病率为0.0026%，一份数据登记报告显示，其中2.4%发生在产后。HDP中椎动脉夹层的实际发病率尚不清楚，因为目前的文献仅由病例系列和报告组成，大多数记录的是不良结局。鉴于存在侧支循环，单侧椎动脉夹层可能未被识别，且可能比怀疑的更为常见。
我们报告了一组4例与HDP相关的椎动脉夹层病例，其中2例发生在产前，2例发生在产后。我们所有的患者都有良好的结局，没有产妇神经功能缺损，且婴儿存活。我们的讨论涵盖了HDP中椎动脉夹层的拟议病理生理学及其管理。
我们的病例系列强调，在评估有头痛和颈部疼痛的孕妇时，尤其是在HDP的情况下，需要将椎动脉夹层视为重要的鉴别诊断。
