Garner Malvina
Klinik für diagnostische und interventionelle Neuroradiologie, Universitätskliniken des Saarlandes, Kirrberger Str., 66421, Homburg Saar, Deutschland.
Radiologie (Heidelb). 2025 Feb;65(2):100-109. doi: 10.1007/s00117-024-01399-6. Epub 2025 Jan 10.
Spontaneous dissections of the cerebral arteries are among the leading causes of stroke in young adults. They result from hemorrhage into the outer layers of the arterial wall, which can lead to stenosis or even complete vessel occlusion. Clinical presentations vary, ranging from localized pain to cerebral ischemic complications. Early recognition of dissection warning signs and diagnosis through imaging is crucial due to the high risk of recurrent transient ischemic attack (TIA) or stroke within the first two weeks following a dissection, necessitating immediate therapeutic or prophylactic intervention.
Magnetic resonance imaging (MRI) is the imaging modality of choice, as it can reliably visualize all characteristic features of dissection. Typically, thin-slice, fat-saturated 3D black-blood sequences are sufficient to detect the pathognomonic intramural hematoma.
Acute treatment and secondary prevention depend on the extent of neurological deficits, the location and size of the dissection, any sequelae, concomitant pathologies, and risk factors. In most cases, spontaneous vascular recanalization or regression of vessel stenosis occurs within several months due to resorption of the mural hematoma.
脑动脉自发性夹层是年轻成年人中风的主要原因之一。它们是由动脉壁外层出血引起的，这可能导致狭窄甚至完全血管闭塞。临床表现各不相同，从局部疼痛到脑缺血并发症。由于夹层后前两周内复发性短暂性脑缺血发作（TIA）或中风的风险很高，因此通过影像学早期识别夹层预警信号并进行诊断至关重要，这需要立即进行治疗或预防性干预。
磁共振成像（MRI）是首选的成像方式，因为它可以可靠地显示夹层的所有特征。通常，薄层、脂肪饱和的3D黑血序列足以检测出具有诊断意义的壁内血肿。
急性治疗和二级预防取决于神经功能缺损的程度、夹层的位置和大小、任何后遗症、伴随的病理情况以及危险因素。在大多数情况下，由于壁内血肿的吸收，自发性血管再通或血管狭窄的消退会在几个月内发生。
