Zhang Fu-Liang, Guo Zhen-Ni, Liu Yang, Luo Yun, Yang Yi
Stroke Center Neuroscience Center, Department of Neurology Department of Radiology, the First Hospital of Jilin University, Chang Chun, China.
Medicine (Baltimore). 2017 May;96(21):e6980. doi: 10.1097/MD.0000000000006980.
Cervicocephalic artery dissections, once considered a rare disease, have become increasingly recognized as a cause of stroke in young and middle-aged individuals. Early diagnosis is mandatory because anticoagulation or antithrombotic therapy can help prevent primary or secondary ischemic events. However, the diagnosis is still a crucial challenge for radiologists and neurologists.
We reported a rare case of 33-year-old patient with progressive ischemic stroke due to dissection from an intimal tear in the right proximal internal carotid artery to distal middle cerebral artery.
3D fat-saturated T1 VISTA imaging, owing to its comprehensive neck and head coverage, high spatial resolution, enables the reader to have several sections with good contrast covering the dissected arterial segment, even in the rare dissection involving extra- and intra-cranial arteries referred in this article.
Clopidogrel 75mg daily was prescribed, also the patient was given rehabilitation training.
His symptoms improved gradually.
We describe that 3D fat-saturated T1 VISTA was helpful for the diagnosis and follow-up in our case of cervicocephalic artery dissection complicated with progressive ischemic stroke. However, for totally acute occlusion of the artery without typical features of dissection, the unequivocal distinction between intramural haematoma and intraluminal thrombus may still be difficult with 3D fat-saturated T1 VISTA alone. Future studies should investigate whether an optimal VISTA technique would be useful for making a definite diagnosis.
颈脑动脉夹层，曾被认为是一种罕见疾病，如今越来越被视为中青年人群中风的一个病因。早期诊断至关重要，因为抗凝或抗血栓治疗有助于预防原发性或继发性缺血性事件。然而，对于放射科医生和神经科医生而言，诊断仍是一项严峻挑战。
我们报告了一例罕见的33岁患者，因右颈内动脉近端至大脑中动脉远端的内膜撕裂夹层导致进行性缺血性中风。
3D脂肪饱和T1 VISTA成像，因其对颈部和头部的全面覆盖、高空间分辨率，即使在本文提及的累及颅外和颅内动脉的罕见夹层病例中，也能让阅片者获得多个对比度良好的层面，覆盖夹层动脉段。
每日给予氯吡格雷75mg，同时对患者进行康复训练。
他的症状逐渐改善。
我们描述了3D脂肪饱和T1 VISTA对我们这例颈脑动脉夹层合并进行性缺血性中风病例的诊断和随访有帮助。然而，对于没有典型夹层特征的动脉完全急性闭塞，仅靠3D脂肪饱和T1 VISTA可能仍难以明确区分壁内血肿和腔内血栓。未来的研究应调查最佳的VISTA技术是否有助于做出明确诊断。
