Retrospective Evaluation of Patients Diagnosed with Vertebral Artery Dissection

Öz

Craniocervicalartery dissection is a rare but important etiological factor in young stroke patients. Genetic and environmental factors are responsible in the etiopathogenesis. The neurological problems caused by dissections occurs due to endotelial damage. The incidence of dissections of vertebral artery (VA) is low, compared to carotid artery dissections. Although vertebral artery dissections are rare, delayed diagnosis or treatment may result in high mortality. This study was aimed to evaluate the patients who were followed up with the diagnosis of vertebral artery dissection in the last eight years and to investigate their prognosis. This study was conducted at University of Heath Sciences, Izmir Bozyaka Training and Research Hospital. Fifteen patients with the diagnosis of VA dissection between January 2013 and 2021 were included in the study. The data of the patients were analyzed retrospectively from hospital information management system. Fifteen patients, 8 (53.3%) male, were included in the study. The mean age was 45.3±15.57 (min-max:24-78) years. Recorded comorbid diseases were hypertension (n=7), diabetes mellitus (n=2), hyperlipidemia (n=2), cerebrovascular disease (n=1). The most common complaints were dizziness (n = 12), speech problem (n=4), nausea and vomiting (n=3), weakness (n=3). Four patients had a history of trauma and two patient had a history of neck massage. Right VA dissection was detected in 5 (33.3%) patients, and left VA dissection in 9 (60%) patients. It was noted that most of the patients (80%) were fully-recovered in the follow-up. Dissection of the carotid or vertebral arteries is the cause for one-fourth of all strokes under 50 years of age. Therefore, cervical artery dissections should be considered in the differential diagnosis of acute ischemic stroke in young adults. In addition, the patients should be closely monitored for effective treatment plan with the multidisciplinary approaches of emergency department, neurology and radiology clinics.

Anahtar Kelimeler

• Dissection
• Cervical artery dissections
• Stroke

Vertebral Arter Diseksiyonu Tanılı Hastaların Retrospektif Değerlendirilmesi

Öz

Kraniyoservikal arter diseksiyonları nadir görülen ancak genç inme hastalarda önemli bir etiyolojik faktördür. Etiyopatogenezde genetik ve çevresel faktörler sorumlu tutulmaktadır. Diseksiyonun neden olduğu nörolojik patolojiler endotelyal hasar nedeniyle meydana gelir. Vertebral arter (VA) sistemine ait diseksiyonlarının insidansı karotid arter diseksiyonlarına kıyasla daha düşüktür. VA diseksiyonları görece daha nadir görülmekle birlikte doğru tanı ve tedavinin gecikmesi fatal sonuçlanabilir. Bu çalışmada, kliniğimizde son sekiz yılda vertebral arter diseksiyonu tanısı ile takip edilmiş olan hastaların değerlendirilmesi ve prognozlarının araştırılması amaçlandı. Bu çalışma SBÜ İzmir Bozyaka Eğitim ve Araştırma Hastanesi Nöroloji Kliniğinde yapıldı. Çalışmaya 1 Ocak 2013 – 1 Ocak 2021 tarihleri arasında servikal arter diseksiyonu tanısıyla takip edilen 15 hasta dahil edildi. Hastalara ait veriler hastane bilgi yönetim sisteminden retrospektif olarak incelendi. Çalışmaya 8’i (%53,3) erkek 15 hasta alındı. Hastaların yaş ortalaması 45,3±15,57 (min-max:24-78) yıldı. Eşlik eden komorbid hastalıklar; hipertansiyon (n=7), diyabetes mellitus (n=2), hiperlipidemi (n=2) ve geçirilmiş serebrovasküler hastalıktı (n=1). Hastaneye en sık başvuru şikayetleri; baş dönmesi (n=12), konuşma bozukluğu (n=4), bulantı ve kusma (n=3), güçsüzlük (n=3) idi. Hastalardan dördünde travma, ikisinde ise boyun bölgesine masaj uygulanma öyküsü vardı. 5 (%33,3) hastada sağ, 9 (% 60) hastada sol vertebral arter diseksiyonu saptanmıştı. Hastaların takiplerinde büyük bölümünün (%80) sekelsiz iyileştiği kaydedildi. Elli yaş altında tüm inmelerin dörtte birinde karotis veya vertebral arterlerin diseksiyonu rol oynar. Bu nedenle genç inme hastalarında, servikal arter diseksiyonu ayırıcı tanıda akla gelmelidir. Ayrıca acil servis, nöroloji ve radyoloji klniklerinin multidisipliner çalışması ile hastalar etkin tedavi planı için yakından izlenmelidir.

Anahtar Kelimeler

• Diseksiyon
• Servikal arter diseksiyonu
• İnme

Kaynakça

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