Desfontaines P, Despland P A
Centre Hospitalier Universitaire Vaudois, Service de Neurologie, Lausanne, Suisse.
Acta Neurol Belg. 1995 Dec;95(4):226-34.
We reviewed the medical records of 60 consecutive patients (28 men and 32 women; aged from 13 to 63 years) with the diagnosis of dissection of the internal carotid artery (ICA), and with available clinical and neurosonological follow-up. Ten cases occurred after trauma and 50 cases were spontaneous. Angiographic evidence of fibromuscular dysplasia of the ICA was found in 23% of the cases. Unilateral headaches or neck pain associated with focal cerebral ischemic symptoms or oculosympathetic palsy were the most common findings. Less frequent symptoms such as isolated cranial nerve palsies and pulsating bruits were also observed. Follow-up ranged from 3 to 144 months (mean, 37.5 months). A favourable outcome occurred in 73.7% of the cases with a follow-up of 6 months or more, and seemed to depend on the severity of the ischemic cerebral deficit associated with the ICA dissection. 68% (41/60 cases) of our patients developed stroke and 18% (11/60 cases) experienced a transient ischemic attack, which occurred as the initial manifestation of the ICA dissection in 28.8% (15/52 cases) of the cases, and with a delay (more than 24 hours) in the other cases. Evidence of embolization in the cerebral arteries was found in 36% of the cases with stroke (15/41 cases). Anticoagulant therapy, given in 34 of our patients, seems to be justified by the fact that a considerable risk exists for cerebral emboli in association with ICA dissections; no serious neurological complications were observed in our series as a result of this anticoagulant therapy. Doppler sonography follow-up diagnosed a recanalization in 67.8% of the stenotic or occlusive dissections, most of them being completed within the first 6 months (92%). Recurrence of ICA dissection is exceptional but occurred in one of our 60 cases, 2.5 years after the first event.
我们回顾了60例连续诊断为颈内动脉（ICA）夹层且有可用临床和神经超声随访资料的患者（28例男性和32例女性；年龄13至63岁）。10例发生于创伤后，50例为自发性。23%的病例发现有ICA纤维肌发育不良的血管造影证据。与局灶性脑缺血症状或眼交感神经麻痹相关的单侧头痛或颈部疼痛是最常见的表现。也观察到了如孤立性颅神经麻痹和搏动性杂音等较不常见的症状。随访时间为3至144个月（平均37.5个月）。随访6个月或更长时间的病例中，73.7%预后良好，且似乎取决于与ICA夹层相关的缺血性脑功能缺损的严重程度。我们的患者中有68%（41/60例）发生中风，18%（11/60例）经历短暂性脑缺血发作，其中28.8%（15/52例）的病例中短暂性脑缺血发作是ICA夹层的初始表现，其他病例有延迟（超过24小时）。36%的中风病例（15/41例）发现脑动脉有栓塞证据。我们的34例患者接受了抗凝治疗，鉴于ICA夹层有发生脑栓塞的相当大风险，抗凝治疗似乎是合理的；在我们的系列病例中，未观察到因这种抗凝治疗导致的严重神经并发症。多普勒超声随访诊断67.8%的狭窄或闭塞性夹层有再通，其中大多数在最初6个月内完成（92%）。ICA夹层复发罕见，但在我们的60例病例中有1例在首次事件2.5年后发生。
