Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
World Neurosurg. 2021 May;149:e1128-e1133. doi: 10.1016/j.wneu.2020.12.118. Epub 2020 Dec 31.
Vertebral artery dissections (VADs) are a rare cause of ischemic stroke that can occasionally lead to intracranial hemorrhage (ICH). This study aims to identify differences in predisposing factors, event characteristics, and outcomes between patients with only a VAD and patients with VAD and concomitant ICH.
We conducted a retrospective chart review of 301 patients who presented with VADs at our institution from 2004-2018. A total of 13 patients were identified with VAD and concomitant ICH. Data were collected on demographics, event characteristics, treatments, and neurologic outcomes, measured using the modified Rankin Scale (mRS).
VAD+ICH and VAD-only groups were similar in terms of age, sex, and recorded comorbidities. Additionally, etiology of the dissections did not seem to vary between groups (P = 0.6), even when selecting for traumatic causes such as motor vehicle accidents (P = 0.22) and violence (P = 0.25). Concomitant strokes and aneurysms/pseudoaneurysms occurred in similar proportions as well, but cervical fractures were more common in the VAD+ICH group (P = 0.003). Using the mRS as a measure of neurological outcome, we found that the VAD+ICH group had worse neurologic function at discharge, 3-month follow-up, and last follow-up (P < 0.001).
Patients who experienced an ICH in addition to a VAD did not have any identifiable risk factors. Cervical spine fractures were more common in patients with VAD and ICH. VAD patients with a concomitant ICH have worse neurologic outcomes than patients with only a VAD.
椎动脉夹层（VAD）是一种罕见的缺血性卒中病因，偶尔可导致颅内出血（ICH）。本研究旨在明确单纯 VAD 患者与 VAD 合并 ICH 患者之间在易患因素、发病特征和结局方面的差异。
我们对 2004 年至 2018 年在我院就诊的 301 例 VAD 患者进行了回顾性病历分析。共发现 13 例 VAD 合并 ICH 患者。收集了人口统计学、发病特征、治疗方法和神经功能结局（采用改良 Rankin 量表[mRS]评估）等数据。
VAD+ICH 组和 VAD 组在年龄、性别和记录并存疾病方面相似。此外，夹层的病因在两组之间似乎没有差异（P=0.6），即使选择创伤性病因，如机动车事故（P=0.22）和暴力（P=0.25）也是如此。同时，并发卒中及夹层动脉瘤/假性动脉瘤的比例也相似，但 VAD+ICH 组更常见颈椎骨折（P=0.003）。采用 mRS 作为神经功能结局的衡量标准，我们发现 VAD+ICH 组在出院时、3 个月随访时和末次随访时的神经功能更差（P<0.001）。
除 VAD 外还发生 ICH 的患者没有任何可识别的危险因素。VAD 合并 ICH 患者更常见颈椎骨折。VAD 合并 ICH 的患者神经功能结局比单纯 VAD 患者差。
