Enchancment and Aggravation of Spontaneous Unruptured Vertebral Artery Dissection.
Cerebrovasc Dis Additional. 2017;7(three):153-164
Authors: Shibahara T, Yasaka M, Wakugawa Y, Maeda Ok, Uwatoko T, Kuwashiro T, Lip GYH, Okada Y
BACKGROUND: Intracranial vertebral artery dissection (VAD) is a well-recognized reason for stroke in younger and middle-aged people, particularly in Asian populations. Nevertheless, a long-term pure course stays unclear. We investigated the long-term time course of VAD utilizing imaging findings to look at the speed and predisposing components for enchancment.
METHODS: We registered 56 consecutive sufferers (40 males; imply age, 51.eight ± 10.7 years) with acute spontaneous VAD and retrospectively investigated neuroimaging and scientific course inside 1 month and at three months ± 2 weeks, 6 months ± 2 weeks, and 12 months ± 2 weeks after onset to establish predisposing components and time course for enchancment.
RESULTS: The commonest presenting signs have been headache and/or posterior neck ache, seen in 41 sufferers (73%). Magnetic resonance imaging confirmed brainstem and/or cerebellum infarction in solely 32 sufferers (57%). Of the 56 VADs, 16 (28%) introduced with pearl and string signal, 5 (9%) with pearl signal, 15 (27%) with string signal, and 20 (36%) with occlusion signal. VAD occurred on the dominant facet in 20 sufferers and on the nondominant facet within the different 36 sufferers. The pearl and string signal was extra regularly famous on the dominant facet than on the nondominant facet (50 vs. 17%, p = zero.008). Alternatively, occlusion occurred extra typically on the nondominant facet than on the dominant facet (47 vs. 15%, p = zero.016). Moreover, the pearl and string signal was extra regularly seen within the enchancment group (41 vs. 15%, p = zero.028), whereas the occlusion signal was evident extra regularly within the nonimprovement group (21 vs. 52%, p = zero.zero15). Comply with-up neuroimaging analysis was carried out at 1 and three months in 91% every, and at 6 and 12 months in 82% every. VAD aggravation was recognized inside 1 month after onset in 14%, whereas VAD enchancment was seen in 14, 38, 50, and 52% at every interval, primarily inside 6 months after onset. Older sufferers and present smoking have been negatively related to VAD enchancment.
CONCLUSIONS: VAD enchancment primarily happens inside 6 months after onset, and VAD aggravation inside 1 month. Plainly older sufferers and present smoking are damaging predictors of VAD enchancment as threat components, and as picture findings, the pearl and string signal is a optimistic predictor and occlusion a damaging predictor.
PMID: 29040967 [PubMed – indexed for MEDLINE]