疼痛発症非出血性頭蓋内椎骨動脈解離の臨床的特徴と転帰

Abstract

In this study, we retrospectively investigated clinical features, radiological follow-up results, and outcome of patients with vertebral artery dissection (VAD) presenting with isolated head-nuchal pain. During the past 5.5 years, we experienced 69 VAD cases diagnosed either by MRI, 3D-CT angiography, or digital subtraction angiography. Among them, 41 patients (59%) who initially presented with only head-nuchal pain and showed neither subarachnoid hemorrhage (SAH) nor cerebral infarction were studied. The age of the patients (27 males, 14 females) ranged from 32 to 83 (mean 43) years. Once VAD was diagnosed, the patients underwent strict blood pressure control (systolic blood pressure ＜120 mmHg) and bed rest. In all cases, serial follow-up MRI examinations were performed for one week to five years after the onset. The radiological findings of VAD were classified into three types: fusiform dilatation (FD), narrowing or occlusion (N/O), pearl and string sign (PSS). As a past clinical history, hypertension was observed in 24 cases, smoking in 14 cases. Moderately severe and persistent occipito-cervical pain (71%) as well as unilateral pain ipsilateral to the affected VA (73%) were characteristics of VAD. The latency of the pain of the patients whose follow-up MRI images were improved or unchanged (mean six days) was significantly shorter than that of the patients whose images were observed aggravate (mean 11 days) (p＜0.03). The initial radiological findings of VAD were FD in 20, N/O in 11, PSS in 10. In all cases, fusiform dilatation of the vascular outer contour of the VA was observed on basiparallel anatomic scanning. Serial MRI showed radiological improvement in 26 cases and deterioration in eight cases. Among the eight patients with deteriorated in MRI images, two underwent endovascular coil embolization. No patients experienced SAH or neurological deficits during follow-up. In patients with persistent unilateral occipito-cervical pain, the possibility of VAD should be considered. In addition, careful observation with a focus on blood pressure control might be required for the patients with unruptured VAD.