頭痛のみで発症した椎骨動脈解離の画像所見の変化と転帰

抄録

Background and Purpose: The natural history and therapeutic management of patients with unruptured vertebral dissections presenting with headache remains unclear. We retrospectively assessed 41 consecutive patients treated for unruptured vertebral dissections that presented with headaches.

Methods: We identified 41 patients diagnosed with vertebral artery dissection through magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and angiography between April 2008 to March 2017 and who experienced only headache at the time of onset. All patients underwent MRI, MRA, or three-dimensional computed tomography (CT) every 1-4 weeks for 3 months, every 1-3 months between 3 and 6 months, every 3-6 months 6 months post-onset, or more often depending on the situation. Clinical characteristics, morphological changes, and treatments were analyzed.

Results: Headaches were posteriorly located in 39 cases, however, there were no specific findings other than location. Primary radiographic investigations showed dilatation in 13 cases, pearl and string signs in 20 cases, and stenosis or occlusion in 8 cases. Following the initial conservative treatment, morphologic changes were improved in 27 cases, dilated and occluded in 8 cases, and remained unchanged in 6 cases. The most morphological changes were seen within 3 months for 35 cases, with a mean time of 1.6 months, however, for 6 cases the mean time was 11.2 months. These 6 patients showed dilation and occlusion as morphological changes. Five of these 6 patients' dissection sites enlarged and 3 underwent surgical treatment at a mean of 7.7 months post-onset. The remaining 2 patients were treated conservatively; their dissection sites healed and decreased. None of the patients experienced bleeding or neurological deficits during follow-up.

Conclusion: Clinicians should monitor patients with unruptured vertebral dissections who present with headache to prevent stroke development. It should be noted that even if the dissection site enlarges without new symptoms, acute intervention is not always required and patients should be treated with careful radiographic follow-up.