43例表现为脑梗死的自发性脑动脉夹层分离的血管影像学表现

目的分析表现为脑梗死的自发性脑动脉夹层分离（caebralaralarty dissection,CAD）的血管影像学表现,探讨其影像学特征。方法回顾表现为脑梗死的自发性CAD患者的影像学和临床资料,分析不同部位CAD在各项血管影像学检查中的特征性表现,并加以归纳总结。结果43例CAD患者纳入研究,男性28例,女性15...     

脑动脉夹层基础与临床研究进展

脑动脉夹层可分为外伤性和自发性两类.前者首例报道早在1947年,是1例继发于头部外伤后的脑动脉夹层;后者为Anderson等[1]于1959年报道第1例自发性颈内动脉夹层.近年来,随着临床认识的加强和影像技术的发展,脑动脉夹层的诊断率已逐步提高.本文主要讨论自发性脑动脉夹层,即颈内动脉系统及椎基底动脉系统夹层,其中颅外段,即颈部动脉,是夹层主要发生部位,是脑动脉夹层研究的主要内容.     

颈动脉夹层动脉瘤的血管内治疗

人们逐步认识到自发性或外伤性颈内动脉颅外段或椎动脉夹层分离是缺血性卒中,尤其是年轻患者卒中的原因之一。虽然确切发病率尚不清楚,但在西方,70岁以下人群中由颈内动脉夹层分离引起的首次卒中占各种原因引起的首次卒中的25%。有资料表明,外伤性动脉夹层分离更容易引起神经功能缺损。病人形成夹层动脉瘤的比例,较自发性夹层分离高,而动脉瘤常发生在那些受累后易引起临床症状的血管。这些动脉瘤的持续存在不仅引起局部症状,如颈部肿胀,而且还形成了可能发生脑血栓的栓子来源,甚至有受累血管自发破裂的危险。作者探讨了使用血管内支架置入技…     

026自发性颈部总动脉夹层分离:1例报告及文献复习

颈内动脉(ICA)颅外段夹层分离是脑梗死的常见病因，占年青人缺血性率中的20．5％，而自发性颈总动脉(CCA)夹层分离罕见，且常伴主动脉夹层分离，单独CCA夹层分离更罕见，现报道1例。     

高分辨率磁共振血管壁成像在脑动脉夹层分离诊断中的价值

目的 探讨高分辨率磁共振(high-resolution magnetic resonance imaging,HR-MRI)血管 壁成像对脑动脉夹层分离(cerebral artery dissection,CAD)的诊断价值.方法 回顾性纳入确诊为CAD且完成CT血管造影(computed tomography angiography,CTA)、磁共振血管造影(magnetic resonance angiography,MRA)、数字减影血管造影(digital subtraction angiography,DSA)和HR-MRI检查的患者,比较和分析4种影像学技术对CAD的检出率和诊断价值.结果 共纳入15例患者,其中颈内动脉夹层分离5例,椎动脉夹层分离7例,大脑中动脉夹层分离2例,基底动脉夹层分离1例.HR-MRI可见壁内血肿11例,内膜瓣9例,双腔征3例,假性动脉瘤2例.15例CAD患者共检出CAD18处,HR-MRI、DSA、CTA和MRA分别检出17处(94.44％)、14处(77.78％)、5处(27.78％)和6处(33.33％),检出率存在显著差异(x2=24.939,P＜0.001),HR-MRI(P均＜0.01)和DSA(P均＜0.05)检出率均显著高于CTA和MRA,但HR-MRI与DSA之间无显著差异.结论 HR-MRI是一种敏感性较高的CAD诊断方法.     

自发性颈动脉夹层分离的复发

自发性动脉夹层分离(AD),常见于中青年,女性略多,可能与外伤、高血压有关。动脉造影则提示10％～15％有动脉纤维肌层发育不良。青年缺血性卒中10％～20％与自发性动脉夹层分离有关,常伴单侧头痛或颈痛,颈内动脉夹层分离可引起眼交感神经麻痹、颅神经障碍和搏动性耳鸣,而椎基动脉系     

家族性与非家族性自发性动脉夹层分离复发危险度比较

为了比较家族性与非家族性自发性动脉夹层分离复发危险度,作者于1990～1996年对200例患有颅外颈内动脉或椎动脉自发性动脉夹层分离患者进行了2年随访。女104例,男96例,平均年龄44.9(16～76)岁。对其中189例(94.5％)作了详细的家族血管病调查,经过复习其影像学资料、住院和尸检记录、死亡证明等来确定是否患有动脉夹层分离。结果200例患者中有10例具有家族史,家庭中有1个或多个成员患有     

自发性颈内动脉夹层CTA表现及特征性临床特点分析

目的分析颈内动脉夹层CT血管成像(CTA)表现及特点,对临床病史、典型症状和体征、发病危险因素进行总结。方法收集2013年8月—2016年12月于我院确诊自发性颈内动脉夹层病人38例(试验组),所有病例均行头颈CTA检查,并经超声复查、数字减影血管成像(DSA)、MRI及MRA或手术证实夹层;收集同时期检查的颈内动脉粥样硬化病人50例为对照组。比较试验组与对照组在临床病史、典型症状和体征、发病危险因素方面的不同,总结试验组CTA表现特点。结果试验组发病年龄平均52.5岁,较对照组(平均62.1岁)年轻,38例中近半数有发病前头颈部疼痛或出现Horner综合征,近期颈部轻度外伤史等更多见于颈内动脉夹层病人(38例中出现5例);颈内动脉夹层CTA主要表现包括内膜瓣及双腔改变、靶征、夹层动脉瘤等特点。结论头颈CTA是一种可靠的能迅速对大多数颈内动脉疾病进行诊断的方法,可充分了解病人的临床病史和发病特点,对颈内动脉夹层诊断有提示作用,在此基础上结合其典型CTA表现,有利于提高该病的诊断准确率。     

多发性颈部血管夹层分离的颅外颈内动脉支架治疗

颈内动脉（ＩＣＡ）颅外段和椎动脉（ＶＡ）的自发性夹层分离是青年人卒中的重要原因，占４５岁以下缺血性卒中的５％～２０％。ＩＣＡ颅外段是自发性夹层分离的好发部位，两侧发生夹层分离的低于１５％，其中１／４～１／２的患者发生卒中。本文为１例两侧ＩＣＡ颅外段和左侧ＶＡ自发性夹层分离病例并对导致明显症状的血管进行了血管内治疗。患者男性，３６岁，既往体健，间歇性、发作性右上肢无力、麻木和视力障碍数日。每次发作持续１５～２０ｍｉｎ，曾就诊家庭医生并行头颅ＣＴ扫描未发现异常，考虑ＴＩＡ。其后，再次发生右上肢末端麻…     

颈内动脉窃血的血流动力学及影像学研究

目的探讨颈总动脉闭塞后颈内动脉窃血的血流动力学及影像学特点。方法选择经脑血管造影证实的一侧颈总动脉闭塞患者15例,通过经颅多普勒(TCD)、磁共振血管造影(MRA)、CT血管成像(CTA)和数字减影血管造影(DSA)综合评估颈内动脉窃血的侧支循环途径。结果 TCD检查显示,颈内动脉窃血的血流动力学特点为病变侧颈外动脉主干血流方向逆转(正向血流频谱)、血流频谱颅内化,病变侧颈内动脉起始段呈低钝血流频谱。DSA显示,颈内动脉窃血途径主要包括:侧支血流从病变侧椎动脉经枕动脉和颈外动脉窃至颈内动脉;侧支血流从病变侧甲状颈干和肋颈干经枕动脉和颈外动脉窃至颈内动脉;侧支血流从病变对侧颈外动脉经甲状腺上动脉吻合和病变侧颈外动脉窃至颈内动脉。MRA和CTA可显示颈总动脉闭塞情况;颈内动脉窃血时,可完整显示由于颈内动脉窃血代偿后正常显影的颈动脉分叉、颈内动脉和颈外动脉;参与侧支代偿的椎动脉和甲状颈干可正常显影。结论临床需结合TCD及影像学检查综合判定颈内动脉窃血的建立情况和具体窃血途径。     

颈部动脉夹层分离

颈部动脉夹层(cervical artery dissection,CeAD)以颈内动脉或椎动脉壁内血肿为特征,是青年人缺血性卒中的主要病因.CeAD的早期识别和治疗对于缺血性卒中的预防具有重要的意义.     

Emergency department presentation of bilateral carotid artery dissections in a postpartum patient

Spontaneous unilateral postpartum carotid arterial dissection is a rarely reported event. This is the first reported case of bilateral carotid artery dissection. A 35-year-old gravida 4, para 3 woman presented to our emergency department with complaint of headache for 3 days. Medical history included delivery of a full-term infant by cesarean section 9 days before presentation because of arrest of descent after 3 hours of pushing. Symptoms were later attributed to a parietal lobe cerebral vascular accident and bilateral internal carotid artery dissection. Physicians should consider the possibility of arterial dissection in any postpartum patient with unremitting headache when evaluation of typical causes fails to lead to a diagnosis. Appropriate diagnostic evaluation and treatment should be actively pursued in this population.     

SPONTANEOUS DISSECTION OF THE INTERNAL CAROTID ARTERY

Abstract: Spontaneous dissection of the internal carotid artery has been considered a relatively rare cause of carotid artery occlusion. It is postulated this condition may not be uncommon and that some cases are not recognised.
The condition is characterised by typical clinical and radiological features which should suggest the diagnosis. Despite these suggestive features it appears that recognition of this condition is not widespread and the diagnosis may not be made.
Three cases of spontaneous dissection are reported. The clinical and radiological features will be emphasised and pathogenesis and treatment discussed.     

颈动脉超声和CT血管成像及DSA在颈动脉夹层诊断中的应用价值

目的探讨颈动脉超声、CT血管成像(CTA)及DSA对颈动脉夹层的诊断价值。方法对24例颈动脉夹层患者的三种影像资料进行回顾性分析。结果 DSA检查24例,CTA检查16例,颈动脉超声检查21例。DSA、CTA、颈动脉超声检查颈动脉夹层的检出率分别为95.8%(23例)、75.0%(12例)、71.4%(15例)。其中DSA显示以线样征最多见,有12例(占50%),CTA检查和颈动脉超声检查均以双腔征多见,分别为37.5%(6例)和52.4%(11例)。颈动脉超声及CTA检出颈动脉夹层与DSA相比,一致率分别为66.7%和81.3%,差异均无统计学意义(分别为Kappa=0.39,P=0.08;Kappa=0.43,P=0.22)。颈动脉超声联合CTA检查与DSA的一致率为87.5%(15例),(Kappa=0.67,P=0.047),差异有统计学意义。结论 DSA是诊断颈动脉夹层的金标准,不可替代。颈动脉超声联合CTA能提高诊断率,颈动脉超声可作为颈动脉夹层的筛查方法。     

40-year-old patient with an aneurysm of the extracranial arteria carotis interna

A case of extracranial internal carotid artery aneurysm Aneurysms of the extracranial internal carotid artery are uncommon but can be responsible for serious complications such as rupture, thrombosis, or embolism. The underlying causes of aneurysm include atherosclerosis, fibromuscular dysplasia, trauma, previous carotid artery surgery, infection, dissection, syphilis and a congenital defect. Five distinct clinical types of aneurysms are reported with different symptoms and treatment. We report a case of extracranial internal carotid artery aneurysm and its successfully surgical treatment.     

Spontaneous dissection of the carotid artery

Spontaneous dissection of the carotid artery is a rare cause of stroke. A 54-year-old man was hospitalized for transient ischemic attack. Duplex ultrasound of cervical arteries showed indirect signs of a dissection of the carotid. Magnetic resonance angiography showed a dissection of the post bulbar segment of the right carotid artery and a right ischemic stroke. Angiography confirmed the diagnosis. The anti-coagulant treatment initialized as soon as the diagnosis of dissection was suspected, was stopped because of a massive cerebral infarct. The course was unfavorable with a persistent hemiplegia.     

Spontaneous dissection of the internal carotid artery. Apropos of 7 cases and a review of the literature

Since 1978, the authors have observed 7 cases of dissecting aneurysm in the internal carotid artery. Symptoms were severe headache and subsequent neurologic deficit in young persons (3 women, 4 men; mean age 35 years). The underlying pathology was spontaneous dissection of the cervical internal carotid artery, with surgical confirmation in 3 cases and typical angiographic patterns in all cases. Spontaneous dissection of the cervical internal carotid artery is being increasingly recognized as a cause of cerebral ischemia in young adults. Moreover this clinicopathologic event is more common than had previously been supposed. The etiology remains unclear, except in 15% of cases in which dystrophy of the media (Marfan's syndrome) is in cause. No history of cervical trauma can be found. Typical clinical features consist in ipsilateral headache preceding an abrupt neurologic deficit in a 40-year-old person. An incomplete Horner syndrome (oculosympathetic paresis without facial anhidrosis) associated with facial pain and numbness is pathognomonic, but the majority of dissections are less typical. The typical angiographic pattern is an elongated regular stenosis of the high cervical internal carotid artery, 2 cm above the non-involved bulbus ("string sign"). The dissection may modify to a tapered occlusion above the point of origin of the internal carotid artery. The natural course is spontaneous resolution of the stricture, without relapse. Optimal management is non-operative since medical treatment has proved to be efficient. These cases confirm the benign course and overall good prognosis of spontaneous dissections of the internal carotid artery which are not as rare as the scarcity of reports might indicate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute monocular blindness associated with spontaneous common carotid artery dissection

The evaluation of patients with loss of vision is common in the emergency department. Central retinal artery occlusion (CRAO) is a potentially reversible cause of acute monocular blindness. When evaluating a patient with CRAO, the potential underlying causes should be considered while simultaneously initiating treatment. We present a case of spontaneous common carotid artery dissection manifesting as CRAO and propose that spontaneous carotid artery dissection be included in the differential diagnosis of CRAO.     

Internal Carotid Artery Dissection Treated with C-Guard Stent

Internal carotid dissection is the most common cause of stroke in the young population. Stroke, the presence of a pseudoaneurysm, and decreased artery lumen with cerebral flow impairment are indications for treatment. Medical therapy with antithrombotic drugs and endovascular therapy with stenting are the main available options. The C-Guard stent is an open cell mesh-covered dual layer stent that has been mainly used in cases of internal carotid artery stenosis with a post-operative reduction in stroke incidence. Thus, we present two cases of internal carotid artery dissections of the cervical segment treated with the open cell dual-layer C-Guard stent without complications.     

Spontaneous Dissection of Internal Carotid Artery Masquerading as Angioedema

Spontaneous dissection of the internal carotid artery usually presents with stroke-like symptoms secondary to ischemia in its vascular territory, as well as local signs and symptoms, which may include head, face or neck pain, Horner’s syndrome, pulsatile tinnitus, and cranial nerve palsies. We report a case of a 44-year-old healthy white male who presented with tongue swelling mimicking angioedema as an unusual manifestation of spontaneous dissection of the internal carotid artery. Two weeks after the initial presentation, the patient returned with similar symptoms and slurred speech. Upon physical examination, he was noted to have isolated left-sided hypoglossal nerve palsy. Subsequent diagnostic imaging revealed segmental narrowing of the left internal carotid artery. The appearance was consistent with the presence of a spontaneous internal carotid artery dissection with associated pseudoaneurysm formation.