Inamasu Joji, Nakae Shunsuke, Kato Yoko, Hirose Yuichi
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
Asian J Neurosurg. 2018 Oct-Dec;13(4):995-1000. doi: 10.4103/ajns.AJNS_373_16.
Arterial dissection (AD) of the vertebral artery (VA) or its branches may cause ischemic stroke of the posterior circulation. However, clinical and radiological characteristics of patients with AD-related cerebellar infarction (CI) have rarely been reported.
Forty-nine patients with CI admitted to our department from April 2008 to March 2015 were identified from our database. After dichotomization into the AD and non-AD group, their demographics and presenting symptoms were compared. Subsequently, a multivariate regression analysis was performed to identify variables that correlated with AD.
During the 7-year period, 14 and 35 patients were identified in the AD and non-AD group, respectively. The AD group was significantly younger than the non-AD group (55.0 ± 16.3 vs. 69.7 ± 10.7 years, = 0.001) and was also more likely to experience acute pain at onset (86% vs. 17%, < 0.001). Using a multivariate regression analysis, these two variables and the male sex were found to correlate with AD. AD was located in extracranial VA ( = 3); intracranial VA ( = 8); posterior inferior cerebellar artery (PICA) ( = 3); and superior cerebellar artery ( = 1). Identification of AD was delayed in one patient with an extracranial VA and one patient with a PICA dissection.
AD was responsible for approximately 30% of CI in our cohort. Pain at onset may be a useful symptom to identify patients with AD-related CI. While intracranial VA was the most common location of AD, physicians should be aware of the possibility of extracranial VA or PICA dissection in patients with seemingly unremarkable radiological findings.
椎动脉（VA）及其分支的动脉夹层（AD）可能导致后循环缺血性卒中。然而，与AD相关的小脑梗死（CI）患者的临床和影像学特征鲜有报道。
从我们的数据库中确定了2008年4月至2015年3月期间收治入我科的49例CI患者。将其分为AD组和非AD组后，比较了两组的人口统计学特征和临床表现。随后进行多因素回归分析以确定与AD相关的变量。
在这7年期间，AD组和非AD组分别有14例和35例患者。AD组明显比非AD组年轻（55.0±16.3岁对69.7±10.7岁，P = 0.001），且发病时更易出现急性疼痛（86%对17%，P < 0.001）。通过多因素回归分析，发现这两个变量以及男性与AD相关。AD位于颅外VA（n = 3）；颅内VA（n = 8）；小脑后下动脉（PICA）（n = 3）；以及小脑上动脉（n = 1）。1例颅外VA和1例PICA夹层患者的AD诊断延迟。
在我们的队列中，AD约占CI的30%。发病时的疼痛可能是识别与AD相关的CI患者的有用症状。虽然颅内VA是AD最常见的部位，但医生应意识到在影像学表现看似正常的患者中存在颅外VA或PICA夹层的可能性。
