Disekcija kraniocervikalnih arterija

Once considered rare, dissection of the internal carotid artery or vertebral artery is an increasingly recognized entity. Craniocervical arterial dissection is an uncommon cause of stroke in the general population, but is relatively common in patients below the age of 40. The early clinical manifestations are often subtle; however, permanent neurologic disability and death can result if the diagnosis is delayed. The present report describes eight patients (four men and four women) with dissection of the craniocervical arteries. Patient history was taken and clinical neurologic examinations were performed immediately upon admission. Diagnostic procedures included ultrasound (CDFI and TCD) and radiologic (computed tomography and digital subtraction angiography) examinations. The leading symptoms were focal neurologic deficits, and headache and neck ache. Ultrasound findings (CDFI) were positive for vessel dissection in seven (87.5%) patients, and DSA was consistent with dissection in five (62.5%) patients and negative in one patient, whereas in two patients this examination was not performed due to the known allergy to contrast medium. Five (62.5%) patients were treated with anticoagulants, one with platelet aggregation suppressants, and two patients were operated on. Six (75.0%) patients showed partial post-therapeutic recovery of neurologic deficits and improvement of ultrasound findings of dissected arteries. One patient developed a stroke postoperatively, with deterioration of the motor deficit, and one patient was readmitted three months later for a newly developed stroke and died soon thereafter. It is concluded that early detection of craniocervical arterial dissection is important to minimize the morbidity and mortality associated with this condition.Disekcija unutarnje karotidne ili vertebralne arterije je rijetka, ali sve češće prepoznata. Disekcija kraniocervikalnih arterija rijetko je uzrokom cerebrovaskularnog inzulta u općoj populaciji, ali je češća u bolesnika mlađe dobi, ispod 40 godina. Rane kliničke manifestacije često su jedva zamjetljive, a u slučaju neprepoznate dijagnoze moguć je trajni neurološki deficit, pa i smrtni ishod. U studiju je bilo uključeno osmoro bolesnika (četiri žene i četiri muškarca) s disekcijom kraniocervikalnih arterija. Odmah nakon prijma uzeti su anamnestički podaci te je učinjen klinički neurološki pregled. Bolesnici su podvrgnuti dijagnostičkim metodama koje su uključivale ultrazvučne (CDFI i TCD) i radiološke ( CT i DSA) pretrage. Vodeći simptomi bolesti bili su žarišni neurološki znakovi i naglo nastala glavobolja i bolovi u stražnjem dijelu vrata. U 7 (87,5%) slučajeva CDFI karotidnih i vertebralnih arterija pokazao je pozitivan nalaz disekcije žile. Petoro (62,5%) bolesnika je imalo pozitivan, a jedan bolesnik negativan nalaz DSA, dok u dvoje bolesnika ova pretraga nije provedena zbog alergije na kontrastno sredstvo. Petoro (62,5%) bolesnika liječeno je antikoagulantnom terapijom, jedan antiagregansima, a dvoje operacijski. U šestoro (75,0%) bolesnika je nakon primijenjene terapije došlo do djelomičnog kliničkog oporavka i poboljšanja ultrazvučnog nalaza na diseciranim krvnim žilama. Jedan je bolesnik nakon operacijskog zahvata doživio recidiv moždanog udara uz pogoršanje neurološkog deficita, a u jednom je slučaju nakon tri mjeseca nastupio recidiv moždanog udara sa smrtnim ishodom. Od velike je važnosti rano prepoznati disekcije kraniocervikalnih arterija, kako bi se smanjio njihov pobol i smrtnost