Department of Neurological Sciences, Christian Medical College, Vellore, India.
Department of Radiodiagnosis, Christian Medical College, Vellore, India.
Eur Spine J. 2020 May;29(5):1078-1086. doi: 10.1007/s00586-020-06337-3. Epub 2020 Feb 19.
The course of the vertebral artery after exiting from the C1 foramen transversarium and prior to entering the dura lends itself to compression in C1-2 instability. However, atlantoaxial dislocation presenting with vertebrobasilar insufficiency and posterior circulation stroke (PCS) is rare.
In this retrospective study, we identified 96 patients with PCS who had complete radiological data. Ten (10.4%) patients had craniovertebral junction (CVJ) anomalies, of which six underwent surgery and four were managed conservatively. The clinical and functional outcomes were measured in the two groups.
Left-sided strokes were seen in 7/10 patients, the majority of whom had left dominant vertebral arteries. The mean age at presentation in those with CVJ anomalies was 27.2 ± 12.8 years that was significantly lower than those without CVJ anomalies, 52.2 ± 14.5 years (p ≤ 0.001). The etiologies of PCS in those < 50 years were CVJ anomalies (30%), atherosclerosis (30%) and vasculitis (27%); however, the overwhelming majority of strokes in the > 50 year age group was atherosclerosis (91%). Postoperatively, there were no recurrent strokes in the operated patients, who also obtained significant clinical improvement on the modified Rankin Scale, Nurick Scale and modified McCormick Scale as compared to those who did not undergo surgery.
Early diagnosis and surgical treatment of CVJ instability prevent recurrent strokes and improve outcomes in patients with PCS. Physicians and spine surgeons need to be sensitized regarding CVJ anomalies as a cause of PCS enabling early diagnosis with dynamic imaging particularly in the younger age group. These slides can be retrieved under Electronic Supplementary Material.
椎动脉在穿过 C1 横突孔后进入硬脑膜前的行程容易在 C1-2 不稳定时受到压迫。然而，以寰枢椎脱位为表现的椎基底动脉供血不足和后循环卒中（PCS）较为罕见。
在这项回顾性研究中，我们共纳入了 96 例 PCS 患者，他们均具有完整的影像学资料。其中 10 例（10.4%）患者存在颅颈交界区（CVJ）异常，其中 6 例行手术治疗，4 例行保守治疗。我们对这两组患者的临床和功能结局进行了测量。
10 例患者中左半边卒中 7 例，其中大多数患者的优势椎动脉为左侧。有 CVJ 异常的患者发病时的平均年龄为 27.2±12.8 岁，明显低于无 CVJ 异常的患者（52.2±14.5 岁，p≤0.001）。年龄<50 岁的 PCS 患者中，PCS 的病因是 CVJ 异常（30%）、动脉粥样硬化（30%）和血管炎（27%）；然而，年龄>50 岁的患者中，绝大多数卒中的病因是动脉粥样硬化（91%）。手术后，手术患者未再发生卒中，与未手术患者相比，他们在改良 Rankin 量表、Nurick 量表和改良 McCormick 量表上的临床改善也更为显著。
早期诊断和治疗 CVJ 不稳定可防止 PCS 患者发生复发性卒中，并改善其预后。医生和脊柱外科医生需要对 CVJ 异常作为 PCS 的病因保持警惕，以便通过动态影像学进行早期诊断，特别是在年轻患者中。这些幻灯片可以在电子补充材料中获取。
