非出血性頭蓋内椎骨動脈解離の画像所見と長期転帰  [in Japanese] Radiological Features and Outcome in Patients with Nonhemorrhagic Intracranial Vertebral Artery Dissection  [in Japanese]

We retrospectively analyzed clinical and radiological features in 16 patients with intracranial nonhemorrhagic vertebral artery dissection. Patients were 13 males and 3 females. Ages were 38-67 years old (51 years old on average). Diagnoses were made on angiography in all but 1 case. Presenting symptoms were cerebellomedullary infarction in 10 cases, posterior neck pain in 3 cases, dysphagia and truncal ataxia in 1, vertigo in 1, and asymptomatic in 1. Angiographical features were pearl and string (PS) sign in 5, string sign in 3, fusiform in 4, double lumen in 1, wide neck saccular in 1, and occlusion in 1 case. Treatment methods were proximal VA occlusion in 3, trapping in 1, intra-aneurysmal coil occlusion with stenting in 1, and observation in 11 cases. Follow-up periods were 10 months-19 years (6 years and 9 months on average). Serial image findings of 5 conservatively treated cases with PS and string sign improved, but those of fusiform and saccular type did not. Outcome : 13 patients showed excellent clinical course without any symptoms. Two patients died of other causes. One patient with an out-pouching aneurysm showing double lumen died of subarachnoid hemorrhage 6 years after initial presentation. As to surgical indication for intracranial nonhemorrhagic vertebral artery dissection, dilatational lesion may be included for prevention of future rupture.