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??Abstract??Cerebral artery dissection (CAD) implies an intimal tear in the wall of cerebral artery leading to the intrusion of blood into layers of the arterial wall (intramural haematoma).CAD has been reported in association with genetic factors??infections??migraine??hypertension and trauma.Clinical manifestations of CAD include headache??Horner’s syndrome??ipsilateral cranial nerves palsy??transient ischemic attack or stroke.Imaging examinations are very important for diagnosis of CAD.Digital subtraction angiography is the golden standard of CAD.Treatment of CAD is essentially depends on pharmacological approaches??and anticoagulant and antiplatelet agents are commonly used.Anticoagulant treatment of six month may fail in a small proportion of patients??and carotid aneurysms??surgical treatment should be performed in refractory patients with high-grade or worsening stenosis.     

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??Abstract??Cerebrovascular dissection??including carotid arterial dissection and vertebral arterial dissection??is an important cause of stroke??especially in young and mid-adult patients.With the widespread use of noninvasive imaging (i.e.magnetic resonance angiography and computed tomographic angiography)??the diagnostic rate of arterial dissection has increased.Treatment methods for cerebral arterial dissection include antiplatelet or anticoagulation therapy??thrombolysis??and endovascular or surgical interventions.Endovascular methods have several advantages??i.e.??a low proportion of perioperative complications and immediate reconstruction of the vessels.Especially in certain cases??endovascular therapy is a safe and useful method.     

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??Abstract??Spontaneous cerebrovascular dissections are subintimal or subadventitial cervical carotid and vertebral artery wall injuries??leading to the intrusion of blood into layers of the arterial wall (intramural hematoma).They are the cause of as many as 2% of all ischemic strokes.Spontaneous dissections are the leading cause of stroke in patients younger than 45 years old??accounting for almost 1/4 of strokes in this population.A history of some degree of trivial trauma is present in nearly 1/4 of cases.Subsequent mortality or neurological morbidity is usually the result of distal ischemia produced by emboli released from the injury site??although local mass effect produced by arterial dilation or aneurysm formation can also occur.The currently accepted method of therapy remains antithrombotic medication in the form of either anticoagulation or antiplatelet agents??however??no class I medical evidence exists to prove which is more effective.     

A hyperdense artery sign and middle cerebral artery dissection

We describe a rare case of spontaneous middle cerebral artery (MCA) dissection that caused cerebral infarction and subarachnoid hemorrhage (SAH), which also presented with a hyperdense artery sign. A hyperdense artery sign of the MCA in acute cerebral infarction strongly indicates thromboembolic MCA occlusion, which is often treated with thrombolytic therapy. However, thrombolytic therapy for intracranial artery dissections has both risks and benefits, due to the association of artery dissections with SAH. Therefore, it is important to keep in mind that an MCA dissection can also cause cerebral infarction with a hyperdense artery sign, particularly in young patients presenting with headache.     

Cervical carotid artery dissection: current review of diagnosis and treatment

Carotid artery dissection is a cause of stroke, especially in young and middle-aged patients. A dissection occurs when there is an intimal tear or rupture of the vasa vasorum, leading to an intramural hematoma, which is thought to result from trauma or can occur spontaneously, and is likely multifactorial, involving environmental and intrinsic factors. The clinical diagnosis of carotid artery dissection can be challenging, with common presentations including pain, partial Horner syndrome, cranial nerve palsies, or cerebral ischemia. With the use of noninvasive imaging, including magnetic resonance and computed tomography angiography, the diagnosis of carotid dissection has increased in frequency. Treatment options include thrombolysis, antiplatelet or anticoagulation therapy, endovascular or surgical interventions. The choice of appropriate therapy remains controversial as most carotid dissections heal on their own and there are no randomized trials to compare treatment options.     

Simultaneous spontaneous coronary and vertebral artery dissection in a postpartum woman

Spontaneous coronary and vertebral artery dissection are rare but life-threatening conditions. They are more prevalent in pregnant and postpartum women with few atherosclerotic risk factors than in the general population. The pathophysiology of spontaneous arterial dissections remains ambiguous and the management may be challenging. We present a case of simultaneous spontaneous coronary and vertebral artery dissection in a postpartum woman. We review the presentation, diagnosis, clinical course and management and place this in context with the existing literature.     

Postpartum cerebral arterial dissections: Clinical features and treatment

Postpartum cerebral arterial dissections are rare, and the clinical features, diagnosis, and treatment approaches are not clear to many physicians. This study was to investigate the clinical features, diagnosis, and treatment of postpartum cerebral arterial dissections.One patient with postpartum cerebral arterial dissections enrolled in our hospital was analyzed. All patients with postpartum cerebral arterial dissections retrieved from the PubMed were also included in this study and analyzed.A total of 45 patients with postpartum cerebral arterial dissections were retrieved including our case, with an age range of 24 to 44 years (mean 34). Thirty-six (80%) patients were older than 30 years of age (mean 35). There were 17 cases of cesarean section, 14 cases of natural labor, and 14 cases whose delivery modes were not reported. The clinical symptoms included headache in 35 cases (78%) and neck pain in 14 (31%). The symptoms occurred at a mean time of 11 days (range 0-53 days) following delivery. Among 45 patients, arterial dissections involved unilateral carotid or vertebral artery in 29 cases (64%), bilateral carotid or vertebral arteries in 8 (18%), 3 arteries in 3 (7%), and all bilateral carotid and vertebral arteries in 5 (11%). Fourteen (31%) patients were treated with antiplatelet agents, 27 (60%) with anticoagulation, 7 (16%) with both antiplatelet and anticoagulation medications, and only 2 (4%) with stent angioplasty. The prognosis was complete recovery in 30 (86%) patients and mild focal neurological symptoms in 5 (14%).Postpartum cerebral arterial dissections are rare, and correct diagnosis relies on imaging examination. Prognosis is usually favorable in patients with early diagnosis and prompt treatment.     

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??Abstract??Carotid artery dissection is a major cause of stroke??especially in young and middle-aged patients.A dissection is thought to result from trauma or can occur spontaneously.Many risk factors have been identified in association with carotid artery dissection such as hereditary factors??systemic arteriopathy??vascular anomaly??hypertension??migraine??trivial neck trauma??cervical spine manipulation and recent infection.Early recognition of these risk factors is favorable to prevention??diagnosis and management of the dissection.     

The treatment of spontaneous carotid and vertebral artery dissections

Spontaneous dissections of the carotid and vertebral arteries in the neck are a common cause of stroke in young and middle-aged people. Moreover, they are increasingly recognized as the cause of a wide variety of other, more subtle, neurologic signs and symptoms. The cause of these arterial dissections largely remains unexplained but probably involves a combination of genetic and environmental factors. Magnetic resonance imaging has largely surpassed angiography as the imaging study of choice. The treatment of carotid and vertebral artery dissections is based on rather incomplete evidence. Anticoagulation with heparin followed by warfarin remains the treatment of choice in most major medical centers and is supported by the demonstration of emboli as the most common cause of stroke in these patients. The burgeoning interest in endovascular techniques has resulted in many patients being treated for carotid and vertebral artery dissections with percutaneous angioplasty and stent deployment. Although the treatment of dissections is generally well tolerated and the radiographic results are impressive, most dissections heal spontaneously and the associated aneurysms never rupture and rarely cause delayed ischemic symptoms. Surgical treatment of dissections, consisting of an in situ interposition graft or extracranial-intracranial bypass, is indicated only for those patients with persistent symptoms refractory to maximal medical therapy who are not candidates for endovascular treatment.     

特发性大脑中动脉夹层三例报告

目的通过对大脑中动脉夹层发病机制及影像学的研究，可进一步了解其发病规律和影像学特点。方法比较3例大脑中动脉夹层患者的MRI、脑血管造影结果及1例尸体解剖资料。结果3例患者均以频繁脑缺血起病，其中1例患者的病情进行性加重，最后死亡。另外2例患者经脑血管造影，1例尸体解剖证实为大脑中动脉夹层，2例患者经动脉支架治疗后效果较好。结论大脑中动脉夹层发病较少见，对于原因不明的大脑中动脉狭窄患者，应首先想到此病，并给予积极治疗。