de Bray J M, Penisson-Besnier I, Giroud M, Klein J, Tanguy J Y, Pasco A, Dubas F
Service de Neurologie A, CHU, Angers.
Rev Neurol (Paris). 1998 Nov;154(11):762-6.
Three cases of extracranial vertebral artery dissections with upper limb peripheral motor deficit (C5-C6) are reported. Six similar cases were also found in the literature. Central neurological symptoms occurred in five of these nine cases, suggesting the diagnosis of dissection. The peripheral motor or sensorial deficit was strictly isolated in the four other cases, simulating radicular neuralgia due to discopathy or foraminal compression. In case of dissections, a precise analysis of pain is helpful to guide diagnosis; sharp, unbearable, continuous and extended neck pain without nocturnal paroxysms and posterior neck stiffness is typical. Analgesics or anti-inflammatory drugs are ineffective. Peripheral motor deficit is more common than sensory deficit. Recovery was complete in this series. In most cases, the radiculopathy appears to be due to cervical root compression in its extraforaminal course due to the dissection hematoma and rarely to radicular ischemia.
报告了3例伴有上肢周围运动功能缺损(C5 - C6)的颅外椎动脉夹层。文献中还发现了6例类似病例。这9例中有5例出现中枢神经症状,提示夹层的诊断。另外4例中周围运动或感觉功能缺损严格孤立存在,类似椎间盘病变或椎间孔受压引起的神经根性神经痛。对于夹层病例,对疼痛进行精确分析有助于指导诊断;典型表现为尖锐、难以忍受、持续且范围广的颈部疼痛,无夜间发作及后颈部僵硬。镇痛药或抗炎药无效。周围运动功能缺损比感觉功能缺损更常见。本系列病例均完全康复。在大多数情况下,神经根病似乎是由于夹层血肿导致椎间孔外行程的颈神经根受压,很少是由于神经根缺血所致。