缘于颈动脉夹层的头痛特征

doi:10.3969/j.issn.1673-5765.2022.05.007

摘要/Abstract

摘要：

目的探讨缘于颈动脉夹层的头痛特征，以期正确识别有头痛症状的颈动脉夹层患者，及时进行相关干预，减少继发于颈动脉夹层的危险并发症，以及防止进行具有潜在危险性的治疗措施和动作。

方法回顾性收集2016年9月-2021年9月浙江大学医学院附属第二医院和浙江中医药大学附属第一医院连续收治的颈部动脉夹层患者的临床资料，重点分析其中缘于颈动脉夹层的头痛患者的临床资料，分析这类患者的头痛特点（部位、性质、强度、持续时间、合并症状等）。

结果最终纳入78例颈部动脉夹层患者，其中9例为缘于颈动脉夹层的头痛患者。9例患者中男性6 例、女性3例，年龄16～70岁，中位年龄52岁。9例患者夹层均位于颈内动脉，头痛主要位于夹层同侧的眼部及额颞部；未发现累及椎-基底动脉的颈部动脉夹层患者。所有缘于颈动脉夹层的头痛患者中，5 例患者头痛性质为钝痛和胀痛，3例患者头痛性质为搏动性或跳痛，1例患者头痛性质为针刺样。1例患者为轻度头痛，6例患者为中度头痛，2例患者为重度头痛。6例患者头痛为持续性，3例患者头痛为阵发性。2例存在既往慢性头痛病史。5例患者合并脑缺血事件（急性缺血性卒中或TIA），5例患者合并霍纳（Horner）综合征。5例患者存在血管危险因素或颈部血管损伤因素。

结论缘于颈部动脉夹层的头痛更常见于颈内动脉夹层，患者多伴有血管危险因素或颈部血管损伤史。缘于颈动脉夹层的头痛部位主要位于夹层同侧的眼部及额颞部且常伴有霍纳综合征，头痛多为中重度，性质、持续时间无特异性。

文章导读： 当头痛患者合并其他神经功能缺损症状如霍纳（Horner）综合征时，应警惕颈动脉夹层的存在。

关键词: 颈动脉夹层; 头痛特征; 影像学特征

Abstract:

Objective To investigate the headache characteristics of patients with cervical artery dissection (CAD), to provide reference for clinical diagnosis and treatment of CAD.

Methods The clinical data of patients with CAD admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine and the First Affiliated Hospital of Zhejiang Chinese Medical University between September 2016 and September 2021 were retrospectively analyzed. Selecting the CAD-related headache patients, the headache characteristics (location, nature, intensity, duration, complications, etc.) of these patients were analyzed.

Results A total of 78 patients with CAD were included, including 9 patients of CAD-related headache. Among the 9 patients, there were 6 males and 3 females, aged from 16 to 70 years, with the median age of 52 years old. The dissection was located in internal carotid artery in all 9 patients, and the headache was mainly located in the eyes and frontotemporal region ipsilateral to the dissection (9 cases).No vertebral artery dissection was found. For the nature of pain, 5 patients presented with dull and distending pain, 3 with throbbing pain, and 1 with stabbing pain. Of the 9 patients, 1 presented with mild headache, 6 with moderate headache, and 2 with severe headache. 6 patients had continuous headache, and the other 3 had intermittent headache. 2 patients had a prior history of headache, and 5 patients had acute ischemic stroke or transient ischemic attack. 5 patients presented with Horner syndrome. 5 patients had vascular risk factors or carotid artery injury factors.

Conclusions CAD-related headache was more common in internal carotid artery dissection. Patients with CAD-related headache often had vascular risk factors or history of cervical artery injury. CAD-related headache was mainly located in the eyes and frontotemporal region ipsilateral to the dissection, and often accompanied by Horner syndrome. The headache was mostly moderatesevere, and the nature and duration of headache were not specific.

Key words: Cervical artery dissection; Headache characteristics; Imaging feature

陈媚娇, 金海娣, 刘恺鸣. 缘于颈动脉夹层的头痛特征[J]. 中国卒中杂志, 2022, 17(05): 477-482.

CHEN Meijiao, JIN Haidi, LIU Kaiming. Headache Characteristics of Carotid Artery Dissection[J]. Chinese Journal of Stroke, 2022, 17(05): 477-482.

参考文献

[1] DEBETTE S，COMPTER A，LABEYRIE M A，et al. Epidemiology，pathophysiology，diagnosis，andmanagement of intracranial artery dissection[J]. Lancet Neurol，2015，14（6）：640-654.
[2] ULUDÜZ D，MASTANZADE T，DEMIRCI S，et al. Headache characteristics and frequency of migraine in patients with cervical artery dissections[J]. Acta Neurol Belg，2021，121（5）：1173-1178.
[3] TORBUS - PALUSZCZAK M，MUCHA S，WAWRZY CZYK M，et al. Hypoglossal nerve palsy in the course of dissection of the internal carotid arteries-case reports[J]. Neurol Neurochir Pol，2018，52（2）：267-273.
[4] 王玉涵，承文超，连亚军. 头颈动脉夹层首发头痛的特点[J]. 中华神经科杂志，2019，52（1）：41-45.
[5] DUCROCQ X，LACOUR J C，DEBOUVERIE M，et al. Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years[J]. Rev Neurol（Paris），1999，155（8）：575-582.
[6] ISSI Z，ERKIN Y，ÖZTÜRK V. Internal carotid ar ter y dissection which mimicr y trigeminal neuralgia and cluster headache[J]. Agri，2020，32（1）：55-57.
[7] ONO H，NAKATOMI H，TSUTSUMI K，et al. Symptomatic recurrence of intracranial arterial dissections：follow-up study of 143 consecutive cases and pathological investigation[J]. Stroke，2013，44（1）：126-131.
[8] WU Y J，CHEN H B，XING S H，et al. Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection[J/OL]. BMC Neurol，2020，20（1）：445[2021-12-04]. https://doi.org/10.1186/s12883-020-02020-8.
[9] Z U BE R M，MEARY E，MEDER J F，et al. Magnetic resonance imaging and dynamic CT scan in cervical artery dissections[J]. Stroke，1994，25（3）：576-581.
[10] FUSCO M R，HARRIGAN M R. Cerebrovascular dissections-a review part Ⅰ：spontaneous dissections[J]. Neurosurgery，2011，68（1）：242-257.
[11] HAKIMI R，SIVAKUMAR S. Imaging of carotid dissection[J/OL]. Curr Pain Headache Rep，2019，23（1）：2[2021-12-04]. https://doi.org/10.1007/s11916-019-0741-9.
[12] Headache Classification Committee of the International Headache Society（IHS）. The international classification of headache disorders，3rd edition（beta version）[J]. Cephalalgia，2013，33（9）：629-808.
[13] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国颈部动脉夹层诊治指南2015[J]. 中华神经科杂志，2015，48（8）：644-651.
[14] ELHFNAWY A M，SOLYMOSI L，SOMMER C. Carotid dissection presenting as a prolonged cluster-like headache in a patient with episodic cluster headache[J/OL]. BMJ Case Rep，2017，2017：bcr2017220845[2021-12-04]. https://doi.org/10.1136/bcr-2017-220845.
[15] ARNOLD M，CUMURCIUC R，STAPF C，et al. Pain as the only symptom of cervical artery dissection[J]. J Neurol Neurosurg Psychiatry，2006，77（9）：1021-1024.
[16] BIOUSSE V，D'ANGLEJAN-CHATILLON J，MASSIOU H，et al. Head pain in non-traumatic carotid artery dissection：a series of 65 patients[J]. Cephalalgia，1994，14（1）：33-36.
[17] CH E N M J，LI H F，M AO S Y. Trigeminal autonomic cephalalgias manifested as the only initial symptom of ehlers-danlos syndrome type Ⅳ[J/OL]. J Pain Res，2019，12：3215-3220[2021-12-04]. https://doi.org/10.2147/JPR.S218580.
[18] VA N D E R Z W E T K V M，BROWN A V，BAKKER S L M. Internal carotid artery dissection presenting with dysgeusia，Horner syndrome，and hypesthesia of the fifth cranial nerve：a case report[J/OL]. J Emerg Med，2019：S0736-4679（19）30818-2[2021-12-04]. https://doi.org/10.1016/j.jemermed.2019.09.035.