Đặc điểm lâm sàng và hình ảnh học của đột quỵ do bóc tách động mạch=Clinical features and imaging findings of stroke due to cervicocephalic artery dissection

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Tác giả: Nguyên Đức Chiêm, Bá Thắng Nguyễn, Thị Ngọc Quyên Phạm, Công Chiến Phan

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.140-147

Bộ sưu tập: Metadata

ID: 242213

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Mô tả các yếu tố nguy cơ, đặc điểm lâm sàng, hình ảnh học của đột quỵ do bóc tách động mạch. Đối tượng và phương pháp: nghiên cứu mô tả hồi cứu, trên các bệnh nhân đột quỵ do bóc tách động mạch nhập khoa thần kinh và khoa ngoại thần kinh bệnh viện Đại học Y Dược thành phố Hồ Chí Minh từ ngày 1/1/2016 - 22/11/2022. Kết quả: 93 bệnh nhân được thu tuyển vào nghiên cứu. Tuổi trung bình 50,9±15,9 tuổi, tuổi ≤ 55 (62,4%), nam giới (72%). Tác động cơ học vùng đầu cổ (13%), liên quan thể thao (5,4%), thủ thuật vật lý vùng đầu (5,4%). Triệu chứng khởi bệnh thường gặp: chóng mặt (31,2%), đau vùng đầu- cổ (25,8%) và yếu chi khu trú (24,7%). Tỉ lệ đột quỵ tái phát khi nằm viện (11,8%). Phát hiện bóc tách động mạch trên MRI-MRA (67,7%), HR-MRI giúp phát hiện thêm (22,6%). Bóc tách động mạch trong sọ (45,2%), ngoài sọ (54,8%%). Hình ảnh đặc trưng thường gặp: khối máu tụ trong thành mạch (44,1%), lòng đôi (37,6%). Điều trị tái thông giai đoạn cấp (10,6%). Điều trị dự phòng tái phát bằng thuốc chống kết tập tiểu cầu (83%), thuốc chống đông (17%). Thời điểm ra viện mRS 0-2 (64,5%). Kết luận: Đột quỵ do bóc tách động mạch chủ yếu ở người trẻ, trung niên nam giới, có 13% do tác động cơ học vùng đầu cổ. Vị trí bóc tách động mạch thường gặp nhất là tuần hoàn sau đoạn trong sọ. Cộng hưởng từ não - mạch não là phương thức hình ảnh có giá trị giúp chẩn đoán đột quỵ bóc tách động mạch, cộng hưởng từ độ phân giải cao giúp tăng khả năng phát hiện bóc tách động mạch trong sọ.To describe the risk factors, clinical features, and imaging characteristics of strokes resulting from cervicocephalic arterial dissection. Subjects and methodology: this is a retrospective descriptive study, carried out on patients with stroke due to cervicocephalic arterial dissection admitted to Neurology and Neurosurgery department at University Medical Center Ho Chi Minh City from January 2016 to November 2022. Results: Ninety-three patients with strokes due to cervicocephalic arterial dissection were identified, constituting 1,5 % of the total stroke patients admitted to the neurology and neurosurgical department from January 1, 2016, to November 22, 2022. The average age was 50,9 ± 15,9 years, with males comprising the majority (72 %), and within this cohort, 62,4 % were aged ≤ 55 years. Risk factors included head and neck mechanical impact, accounting for 13%, with sports 5,4% and chiropractic manipulation of the cervical spine 5,4 %. Common presenting symptoms included dizziness (31,2%), head-neck pain (25,8 %), and localized limb weakness (24,7%). Recurrent stroke during hospitalization was observed in 11,8% of cases. Detection of major cervicocephalic arterial dissection by MRIMRA constituted 67,7%. HR-MRI additionally detected 22.6% more cases. Typical images of cervicocephalic arterial dissection were intramural hematoma (44,1%), and double lumen (37,6%). Acute revascularization treatment was necessary in 10,6%. For preventive treatment, the majority of patients (83%) received antiplatelet drugs, while the remaining (17%) were prescribed anticoagulants. At the time of discharge, (64,5%) of patients exhibited a good functional condition (mRS 0-2). Conclusion: In our study, strokes due to cervicocephalic arterial dissection were common in young to middle-aged men, and only (13%) have head and neck mechanical impact. The most frequent site of cervicocephalic arterial dissection was intradural segment in the posterior circulation. Magnetic resonance angiography proved to be a valuable imaging method for diagnosing cervicocephalic arterial dissection stroke, with high-resolution magnetic resonance imaging enhancing detection, especially in cases of intracranial artery dissection.

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