颈脑动脉夹层所致缺血性卒中患者的头痛与颈部疼痛。一项病例对照研究。

The Headache and Neck Pain in Ischemic Stroke Patients Caused by Cervicocerebral Artery Dissection. A Case-Control Study.

作者信息

Wang Yuhan, Cheng Wenchao, Lian Yajun

机构信息

Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China.

出版信息

J Stroke Cerebrovasc Dis. 2019 Mar;28(3):557-561. doi: 10.1016/j.jstrokecerebrovasdis.2018.10.034. Epub 2018 Nov 16.

DOI:10.1016/j.jstrokecerebrovasdis.2018.10.034

PMID:30455101

Abstract

BACKGROUND AND PURPOSE

The symptom of headache and neck pain is common in patients with cervicocerebral artery dissection (CAD). We attempt to screen ischemic stroke patients with CAD based on the characteristics of the pain.

METHODS

Eighty-one consecutive ischemic stroke patients with CAD from 2010 to 2017 and 84 consecutive ischemic stroke patients with large artery atherosclerosis (LAA) were registered prospectively and observed in Zhengzhou, China. Those ischemic stroke patients complained of headache and neck pain were categorized into 2 groups. By analyzing the difference of headache and neck pain in 2 groups, we summarized characteristics of the pain secondary to CAD.

RESULTS

There were 34 patients in CAD group and 19 patients in LAA group. As for patients in CAD group, the pain could be located in the ipsilateral (41.9%), bilateral (41.9%), or contralateral (16.1%) side of the dissected artery, but in LAA group the pain was often in both sides (68.4%). When the dissected artery was involved in anterior circulation, 55.6% of CAD patients had pain in temporal and when involved in posterior circulation, 65.2% of CAD patients had pain in the occipital and neck. Patients with CAD had a higher prevalence of throbbing pain (30.0%), while pulsating pain (43.8%) was more common in LAA group. Patients often presented with severe pain (46.9%) in CAD group, while less frequently (11.8%) in LAA group, with a significant difference (P = .003). And there was a significant difference between the length (≥20 mm) of the involved artery and severity of the pain (P = .028) in CAD group.

CONCLUSIONS

Ischemic stroke patients caused by CAD tend to suffer from headache and neck pain, which may be severe and throbbing, compared with those resulting from LAA. The anterior circulation dissection has a higher prevalence of temporal pain while posterior circulation dissection is typically more associated with occipital and neck pain.

摘要

背景与目的

头痛和颈部疼痛症状在颈脑动脉夹层（CAD）患者中很常见。我们试图根据疼痛特征筛查患有CAD的缺血性卒中患者。

方法

2010年至2017年连续纳入81例患有CAD的缺血性卒中患者以及84例连续患有大动脉粥样硬化（LAA）的缺血性卒中患者，并在中国郑州进行前瞻性登记和观察。那些主诉头痛和颈部疼痛的缺血性卒中患者被分为两组。通过分析两组头痛和颈部疼痛的差异，我们总结了CAD继发性疼痛的特征。

结果

CAD组有34例患者，LAA组有19例患者。对于CAD组患者，疼痛可位于夹层动脉的同侧（41.9%）、双侧（41.9%）或对侧（16.1%），但LAA组疼痛常位于双侧（68.4%）。当夹层动脉累及前循环时，55.6%的CAD患者有颞部疼痛，当累及后循环时，65.2%的CAD患者有枕部和颈部疼痛。CAD患者搏动性疼痛的患病率较高（30.0%），而LAA组搏动性疼痛（43.8%）更常见。CAD组患者常表现为重度疼痛（46.9%），而LAA组则较少见（11.8%），差异有统计学意义（P = 0.003）。CAD组受累动脉长度（≥20 mm）与疼痛严重程度之间存在显著差异（P = 0.028）。