Hori Emiko, Hori Satoshi, Okamoto Soshi, Shibata Takashi, Umemura Kimiko Oya, Kubo Michiya, Furui Eisuke, Horie Yukio, Kuroda Satoshi
Department of Neurosurgery, Saiseikai Toyama Hospital.
No Shinkei Geka. 2018 Apr;46(4):295-299. doi: 10.11477/mf.1436203719.
Sudden onset severe occipital/nuchal pain is believed to be a typical symptom of vertebral artery dissection(VAD). However, recent developments in diagnostic imaging have suggested that VAD is not always associated with such pain. This study aimed to analyze the clinical features of initial symptoms in patients with VAD.
In total, this study included 29 consecutive patients who were referred to our hospital because of only headache and/or nuchal pain due to VAD between 2011 and 2016. In this study, their clinical features were precisely assessed, including the pain location, onset pattern, duration, intensity, disease period, diagnosis modality, and prognosis. Both MRI and MRA were performed for all subjects. Cerebral angiography and thin-slice T1-weighted MRI were additionally performed in selected cases.
Of the 29 patients, 23 presented with occipital headache and/or nuchal pain. The pain was persistent in 26/29 and ipsilateral in 29/29. However, only 16/29 reported a typical sudden onset. Only 12/29 complained of severe pain, while the other 17/29 presented with dull pain. The mean interval between onset and hospitalization was 7.4 days(0 to 30 days)and the mean interval between hospitalization and diagnosis was 3.9 days(0 to 21 days). Intramural hematoma was identified in 21/29 patients using thin-slice T1-weighted MRI.
Only 55% of patients with VAD demonstrate typical occipital/nuchal pain with sudden onset. Both MRI and MRA should be indicated for patients who complain of persistent, unilateral pain in the occipital/nuchal regions to prevent VAD being missed during diagnosis.
突发严重枕部/颈部疼痛被认为是椎动脉夹层（VAD）的典型症状。然而，诊断成像技术的最新进展表明，VAD并不总是伴有此类疼痛。本研究旨在分析VAD患者初始症状的临床特征。
本研究共纳入29例在2011年至2016年间因VAD导致单纯头痛和/或颈部疼痛而转诊至我院的连续患者。在本研究中，对他们的临床特征进行了精确评估，包括疼痛部位、发作模式、持续时间、强度、病程、诊断方式和预后。所有受试者均进行了MRI和MRA检查。部分病例还额外进行了脑血管造影和薄层T1加权MRI检查。
29例患者中，23例表现为枕部头痛和/或颈部疼痛。26/29例疼痛持续存在，29/29例疼痛位于同侧。然而，只有16/29例报告为典型的突发起病。只有12/29例主诉严重疼痛，而其他17/29例表现为钝痛。起病至住院的平均间隔为7.4天（0至30天），住院至诊断的平均间隔为3.9天（0至21天）。使用薄层T1加权MRI在21/29例患者中发现了壁内血肿。
只有55%的VAD患者表现出典型的突发枕部/颈部疼痛。对于主诉枕部/颈部区域持续性单侧疼痛的患者，应进行MRI和MRA检查，以防止诊断过程中漏诊VAD。
