Inoue Satoshi, Fujita Atsushi, Shinoda Kouji, Yamashita Shunsuke, Lee Te Jin, Kuroda Ryuichi, Takeda Naoya, Urui Seishirou, Kurihara Eiji, Sasayama Takashi
Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan.
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
J Neuroendovasc Ther. 2022;16(5):265-269. doi: 10.5797/jnet.cr.2021-0033. Epub 2021 Sep 11.
We report a patient with normal imaging findings at the onset of preceding headache who developed subarachnoid hemorrhage (SAH) due to intracranial vertebral artery dissection 7 days later.
A 51-year-old woman with a history of chronic headache visited our emergency outpatient department with a complaint of mild to moderate right nuchal pain. CT, MRA, and MRI (diffusion-weighted image, T2-weighted image, FLAIR, MR cisternography, and basi-parallel anatomical scanning) were normal. Seven days later, she was admitted to our hospital with sudden disturbance of consciousness. CT revealed SAH and CTA demonstrated dilatation of the right vertebral artery (VA). The dilated lesion with an intimal flap on the right VA proximal to the posterior inferior cerebellar artery was confirmed on DSA. The dilated lesion and the proximal VA were occluded endovascularly using coils. The condition of the patient improved gradually, and she was transferred to the rehabilitation hospital on day 45 with a modified Rankin Scale score of 2.
The clinical course of the presented case, although rare, should be kept in mind in daily clinical practice.
我们报告一名患者，其在先前头痛发作时影像学检查结果正常，但7天后因颅内椎动脉夹层形成而发生蛛网膜下腔出血（SAH）。
一名有慢性头痛病史的51岁女性因轻度至中度右侧颈部疼痛就诊于我院急诊门诊。CT、MRA和MRI（弥散加权成像、T2加权成像、液体衰减反转恢复序列、磁共振脑池造影和基底平行解剖扫描）均正常。7天后，她因突发意识障碍入住我院。CT显示SAH，CTA显示右侧椎动脉（VA）扩张。DSA证实右侧VA在小脑后下动脉近端有内膜瓣的扩张病变。使用弹簧圈对扩张病变和近端VA进行血管内闭塞。患者病情逐渐好转，45天时以改良Rankin量表评分为2分转入康复医院。
本病例的临床过程虽罕见，但在日常临床实践中应予以关注。
