自发性颈内动脉夹层PPT演示课件

.,1,病例回顾,患者，男，23岁，发现“高血压5年，头晕伴呕吐5天”既往史：左侧肾上腺及旁肿物切除，病理示异位脾，肾上腺增生5天前突发头晕，伴呕吐、伴左侧肢体乏力、言语不清，无头痛、视力模糊查体：血压162/115mmHg,.,2,病例回顾11100999(2015-8-21),T2WI,T1WI,FLAIR,DWI,.,病例回顾11100999（2015-8-27）,3,.,4,病例回顾11100999(2015-9-2),TOF-MRA,.,5,病例回顾11100999(2015-9-2),PDWI-VISTA(SPIR),自发性颈内动脉夹层Spontaneous Internal Carotid Artery Dissection,周彩红 黄飚,.,7,颈内动脉夹层概述,发病率2.5/10万-3.0/10万占缺血性脑卒中 2%中青年缺血性脑卒中10-25%年龄及性别差异任何年龄-50岁多见无明显性别差异,.,8,颈内动脉夹层,正常血管壁,A,B,C,D,夹层,双腔征,壁内血肿,.,9,37岁，女，确诊颈内动脉夹层,.,10,颈内动脉夹层病因,先天性因素Ehlers-Danlos综合征（埃勒斯-当洛综合征）马方综合征成骨不全症弹性假黄瘤后天性因素高血压纤维发育不良感染：呼吸道感染为主外源性创伤其他：如吸烟、口服避孕药等,.,11,自发性颈内动脉夹层,岩段为最常见部位占中青年缺血性脑卒中5%-20%病因不明，可能与岩骨撞击有关,.,12,自发性颈内动脉夹层,临床表现多样化典型三联征患侧头痛、面或颈痛霍纳综合征数小时或数天出现脑或视网膜缺血症状,.,13,彩色多普勒超声,优点 无创、方便、快捷、价廉、可重复典型声像图高回声的动脉内膜瓣 血管内漂浮的血栓 壁内血肿等,MICHAEL ROSENKRANZ B E, WOLF-DIRK NIESEN. Horner Syndrome Related to Ipsilateral Carotid Wall Hematoma after Stent Placement for the Treatment of Carotid Stenoses J. AJNR American journal of neuroradiology, 2003, 24(5): 1508-11.,.,14,MRI及MRA,优点无创、敏感性高、准确率高影像学表现MRA仅能显示动脉的狭窄及闭塞MRA原始图像可显示部分假腔,.,15,高分辨动脉管壁MRI,优点清晰显示动脉管壁，准确显示病变的部位影像学表现壁内血肿：动脉壁新月形高信号直接显示假腔,.,16,CT及CTA,优点创伤性小、检查时间短 敏感性高、特异性高影像学表现血管的不规则狭窄、闭塞 撕裂的内膜瓣 双腔征、假性动脉瘤,VERTINSKY A T, SCHWARTZ N E, FISCHBEIN N J, et al. Comparison of multidetector CT angiography and MR imaging of cervical artery dissection J. AJNR American journal of neuroradiology, 2008, 29(9): 1753-60.,.,17,数字减影血管造影（DSA）,金标准？影像学表现直接征象 双腔征、假性动脉瘤 双向血流 晚期动脉显像造影剂夹层内滞留 间接征象脉管腔呈线珠状、波纹征、线样征缺点创伤性，操作繁琐，并发症多，费用高昂,S W, CHIEVINK M D. Spontaneous dissection of the carotid and vertebral arteries J. N Engl J Med, 2001, 344(12): 898-906,.,18,病例一：男， 32岁，打篮球时突发头晕，下肢乏力,DWI,MRA,DSA,支架术后DSA,李军苗,李海军. 颈动脉夹层3例报告并文献复习 J. 吉林医学, 2012, 33(20): 4463-4465.,.,19,病例二：女， 33岁，突发右侧头痛并霍纳综合征,MRA T1WI压脂,.,20,治疗及预后,抗凝治疗静脉注射肝素口服华法林、阿司匹林外科或血管介入手术血管结扎并血管旁路再建球囊扩张、金属支架植入术预后死亡率5%75%脑中风患者预后良好90%头痛患者可缓解,.,21,总结,颈内动脉岩段夹层中青年缺血性脑卒中5%-20%影像学检查方法及征象B超：壁内血肿，管腔狭窄CT及CTA：管腔狭窄、假性动脉瘤、真假腔DSA：双腔征、假性动脉瘤、管腔细线样狭窄MRI及MRA：壁内新月形高信号，高分辨动脉管壁MR是最好的方法。,.,22,参考文献,1 TOMASZ NESTERUK1 M N, MARTA BULIK-PASISKA1, DARIUSZ BOROSZKO1. Brainstem ischemic stroke without permanent sequelae during the course of spontaneous internal carotid artery dissection case report J. Pol J Radiol, 2012, 77(1): 58-62.,2 VERTINSKY A T, SCHWARTZ N E, FISCHBEIN N J, et al. Comparison of multidetector CT angiography and MR imaging of cervical artery dissection J. AJNR American journal of neuroradiology, 2008, 29(9): 1753-60.,3 HANELINE M T, ROSNER A L. The etiology of cervical artery dissection J. Journal of chiropractic medicine, 2007, 6(3): 110-20.,4 MICHAEL ROSENKRANZ B E, WOLF-DIRK NIESEN. Horner Syndrome Related to Ipsilateral Carotid Wall Hematoma after Stent Placement for the Treatment of Carotid Stenoses J. AJNR American journal of neuroradiology, 2003, 24(5): 1508-11.,5 S W, CHIEVINK M D. Spontaneous dissection of the carotid and vertebral arteri