Komatsu Kenichi, Ozaki Akihiko, Iwasaki Koichi, Matsumoto Sadayuki
Department of Neurology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan.
Intern Med. 2016;55(22):3365-3368. doi: 10.2169/internalmedicine.55.6956. Epub 2016 Nov 15.
Vertebral arteries (VAs) are vulnerable to mechanical stress between the atlas and axis, and subsequent VA dissection can cause posterior circulation infarction. We herein present a rare but informative case of bilateral VA aneurysms that caused recurrent stroke. The localization of the aneurysms and dynamic angiography with neck movement suggested a pathogenesis related to chronic mechanical injury of the VAs, though no skeletal abnormality was detected. The recurrences stopped and both aneurysms shrank after neck collar fixation and after the combination use of antithrombotics. For patients with posterior circulation infarction of unknown origin, a careful evaluation of VAs with physicians paying special attention to the atlantoaxial joint level is therefore recommended.
椎动脉（VAs）在寰椎和枢椎之间易受机械应力影响，随后的椎动脉夹层可导致后循环梗死。我们在此报告一例罕见但具有参考价值的双侧椎动脉动脉瘤导致复发性卒中的病例。动脉瘤的定位以及颈部运动时的动态血管造影提示其发病机制与椎动脉的慢性机械损伤有关，尽管未检测到骨骼异常。颈托固定以及联合使用抗血栓药物后，复发停止且两个动脉瘤均缩小。因此，对于病因不明的后循环梗死患者，建议医生对椎动脉进行仔细评估，尤其要关注寰枢关节水平。
