Characteristics of high-resolution magnetic resonance vessel wall imaging of cervicocerebral artery dissection and the influential factors of vascular recanalization / 中南大学学报(医学版)

OBJECTIVES@#Cervicocerebral artery dissection (CAD) is one of the important causes for ischemic stroke in young and middle-aged people. CAD is dangerous and untimely diagnosis and treatment are likely to result in severe disability. Early diagnosis and timely intervention can greatly improve the prognosis of patients. This study was to investigate the imaging features of CAD on high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) and to analyze the influential factors of vascular recanalization.@*METHODS@#A total of 19 CAD patients with both baseline HRMR-VWI and follow-up data of vascular imaging in the period from April 2017 to December 2019 in Department of Radiology, Xiangya Hospital, Central South University were retrospectively analyzed. The diseased vessels were divided into a recovery group and a unrecovered group. After treatment, diseased vessels with no residual arterial dissection and no residual stenosis in the lumen were included in the recovery group. Diseased vessels with stenosis, occlusion or residual dissection were included in the unrecovered group. Diseased vessels were divided into a ischemic stroke group and a non-ischemic stroke group according to the presence or absence of ischemic stroke in the area supplied by the diseased vessels. Differences in clinical data and HRMR-VWI imaging findings were compared between the groups.@*RESULTS@#A total of 26 vessels were involved, including 14 (53.8%) internal carotid artery extracranial segment, 8 (30.8%) vertebral artery extracranial segment, 3 (11.5%) vertebral artery intracranial segment, and 1 (3.9%) basilar artery. Ischemic stroke occurred in 16 diseased vascular supply areas. Intramural hematoma was all observed in the baseline HMR-VWI of the affected vessels. There were 18 vessels (69.2%) in the recovery group and 8 vessels (30.8%) in the unrecovered group. Compared with the vessels in the recovery group, the vessels in the unrecovered group were mostly found in the intracranial segment (@*CONCLUSIONS@#Intramural hematoma is a common imaging manifestation of CAD and can be shown clearly and accurately on HRMR-VWI. Recanalization rate of CAD is high, and the recanalization of CAD in intracranial segment is slower than that of CAD in extracranial segment, which can prolong the review time.

Characteristics of primary headache caused by cervicocerebral artery dissection / 中华神经科杂志

Objective To analyze the characteristics of the primary headache due to cervicocerebral artery dissection (CAD).Methods A total of 146 consecutive patients with CAD in the First Affiliated Hospital of Zhengzhou University from 2010 to 2017 were observed.There were 20 cases who complained of primary headache,of which the characteristics of pain were analyzed according to their clinical features that were collected face to face through questionnaire.According to whether complicated by primary headache,the 146 patients were classified into two groups:20 cases (13.7％) in the primary headache group,and 126 cases (86.3％) in the non-primary headache group.Results Patients in the primary headache group had a lower prevalence of transient ischemic attack or cerebral infarction compared with the non-primary headache group (30.0％ (6/20) vs 77.0％ (97/126),x2=18.338,P＜0.01).CAD patients in the primary headache group were more likely involved in posterior circulation compared with the non-primary headache group (85.0％ (7/20) vs 55.6％ (70/126),x2=6.214,P=0.013).Of the 20 patients with primary headache,40.0％ (8/20) had continuous headache and 60.0％ (12/20) had intermittent headache;70.0％ (14/20) presented with severe headache,25.0％ (5/20) with moderate headache and 5.0％ (1/20) with mild headache;For the nature of pain,60.0％ (12/20) was similar to migraine;11/17 of patients with posterior circulation dissection showed occipital pain.Conclusions The primary headache caused by CAD is a severe pain occurring suddenly,and different from those of previous experiences.The nature of headache is often similar to migraine,which can be continuous or intermittent.In addition,compared with anterior circulation,patients with posterior circulation dissection often have headache as the initial symptom.