Retrospective Evaluation of Patients Diagnosed with Vertebral Artery Dissection

Yıl 2022, , 845 - 850, 28.11.2022

Neslihan Eşkut , Yaprak Özüm Ünsal , Aslı Köşkderelioğlu , Dilek Top Karti , Pınar Ortan , Rifat Reha Bilgin

https://doi.org/10.20515/otd.1115662

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

• 1. Beletsky V, Nadareishvili Z, Lynch J, et al.; Canadian Stroke Consortium. Cervical arterial dissection: time for a therapeutictrial? Stroke. 2003;34:2856-60.
• 2. Goeggel Simonetti B, Mono ML, Huynh-Do U, et al. Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS). J Neurol. 2015;262:2025-32.
• 3. Yesilot Barlas N, Putaala J, Waje-Andreassen U, et al. Etiology of first-ever ischaemic stroke in European young adults: the 15 Cities Young Stroke Study. Eur J Neuro. 2013;20:1431–9.
• 4. Caplan LR, Biousse V. Cervicocranial arterial dissections. J Neuroophthalmol. 2004;24:299-305.
• 5. Thanvi B, Munshi SK, Dawson SL, Robinson TG. Carotid and vertebral artery dissection syndromes. Postgrad Med J. 2005;81:383-8.
• 6. Bogousslavsky J, Regli F. Ischemicstroke in adults younger than 30 years of age. Cause and prognosis. ArchNeurol. 1987;44:479-82.
• 7. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 200;344:898-906.
• 8. Schievink WI, Mokri B, O'Fallon WM. Recurrent spontaneous cervical-arterydissection. N Engl J Med. 1994;330:393-7
• 9. Yusuf Babashova L, Omercikoglu Ozden H, Baltacioglu F, Midi İ. Lesion localization, etiology and demographic evaluation in spontaneous cerebral and cervical arteries dissection. Turk J Cereb Vasc Dis. 2020; 26: 113-9.
• 10. Debette S, Compter A, Labeyrie M-A, et al. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol. 2015;14:640-54.
• 11. García-Moncó JC, Fernández Cantón G, Gómez Beldarrain M. Bilateral vertebral artery dissection in a patient with afibrinogenemia. Stroke. 1996;27:2325-7.
• 12. Hostettler C, Williams T, Mc Knight C, Sanchez A, Diggs G. Traumatic carotid artery dissection. Mil Med. 2013; 178: e141-5.
• 13. Fukuhara K, Ogata T, Ouma S, et al. Impact of initial symptom for accurate diagnosis of vertebralartery dissection. Int J Stroke. 2015;10:30-3.
• 14. Saver JL, Easton JD, Hart RG. Dissections and trauma of cervico-cerebralarteries. Stroke. Edit. Barnett HJM, Mohr JP, Stein BM, Yatsu FM. Second edition. New York, 1992; 671-688.
• 15. Saeed AB, Shuaib A, Al-Sulaiti G, Emery D. Vertebral artery dissection: Warning symptoms, clinical features and prognosis in 26 patients. Can J Neurol Sci. 2000;27:292-6
• 16. Mokri B, Houser OW, Sandok BA, Piepgras DG. Spontaneous dissections of the vertebral arteries. Neurology. 1988;38:880–5.
• 17. Çabalar M, Uysal S, Demirtaş Tatlıdede A, Selçuk HH, Kara B, Yayla VA. Vertebral Arter Diseksiyonunda Klinik ve Radyolojik Değerlendirme. Türk beyin Damar hastalıkları dergisi .2013;19:23-7
• 18. Park KW, Park JS, Hwang SC et al. Vertebral Artery Dissection: Natural History, Clinical Features and Therapeutic Considerations. Journal of Korean Neurosurc Soc. 2008;44: 109-15.
• 19. Chang AJ, Mylonakis E, Karanasias P, De Orchis DF, Gold R. Spontaneous bilateral vertebral artery dissections: case report and literature review. Mayo ClinProc. 1999;74:893-6.
• 20. Cervical Artery Dissection in Stroke Study investigators. Antiplatelet therapy vs anticoagulation in cervical artery dissections: Rationale and design of the Cervical Artery Dissection in StrokeStudy (CADISS). Int J Stroke. 2007;2:292-6
• 21. Markus HS, Levi C, King A, et al. for he Cervical Artery Dissection in Stroke Study investigators. Antiplatelet therapy vs anticoagulation in cervical artery dissections. Cervical Artery Dissection in Stroke Study (CADISS). JAMA Neurol. 2019;76:657-64
• 22. Jing P, Liu Z, Luo C et al. Treatment of Cervical Artery Dissection: Antithrombotics, Thrombolysis, and Endovascular Therapy. Biomed Res Int. 2017; 2017: 3072098.
• 23. Debette S, Leys D. Cervical artery dissections: predisposing factors, diagnosis and outcome. Lancet Neurol. 2009;8:668-78
• 24. Stahmer SA, Raps EC, Mines DI. Carotid and vertebral artery dissections. Emerg Med Clin North Am. 1997;15:677-98.
• 25. deBray JM, Penisson-Besnier I, Dubas F, Emile J. Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis. J Neurol Neurosurg Psychiatry. 1997;63:46-51.