Dissecção espontânea cervical carotídea e verbal: estudo de 48 pacientes

Abstract

, Milberto Scaff 4 RESUMO -Objetivo: Dada a ausência de estudos de séries brasileiras de pacientes com dissecção arterial cervical espontânea, com o objetivo de descrever os fatores de risco, sintomas precedentes, manifestações clínicas, resultados da investigação, tratamento e evolução. Método: realizamos a análise retrospectiva dos prontuários e laudos radiológicos [angiografia digital(AD), ressonância magnética(RM) e ângio-ressonância(ARM)] dos pacientes com esse diagnóstico atendidos no Serviço de Neurologia do HC/USP entre 1997 e 2003. Resultados: 48 pacientes (24 homens), média de idade 37,9 anos; 26 pacientes com dissecção carotídea (DC) unilateral, 15 com vertebral (DV) unilateral e 7 com multiarterial, todos com déficits neurológicos. Os principais fatores de risco para doença vascular foram hipertensão arterial, tabagismo e dislipidemia. Mais de 80% apresentaram pelo menos um sintoma precedente, na maioria cefaléia têmporo-parietal. Cervicalgia foi referida por 44% dos pacientes com DV e por 3,4% dos com DC. O tempo médio entre o primeiro sintoma e o déficit foi 5,4 dias para as DC e 13,5 para as DV.AD foi o principal método diagnóstico (93%), associado a RM e ARM em 42% dos casos. Em 3 pacientes a RM cervical com supressão de gordura foi isoladamente suficiente. 75% dos pacientes receberam anticoagulação. Dois pacientes fizeram trombólise endovenosa sem complicações. A evolução foi boa, exceto por dois óbitos (DC bilateral). Conclusão: Os resultados são semelhantes aos da literatura, exceto pela baixa freqüência de cervicalgia nos casos de DC e pelo predomínio de cefaléia têmporo-parietal nas dissecções arteriais cervicais. Fatores de risco para doença vascular isquêmica foram frequentes. PALAVRAS-CHAVE: dissecção arterial, artéria carótida interna, artéria vertebral, angiografia, ressonância magnética. Spontaneous cervical carotid and vertebral arteries dissection -Study of 48 patientsABSTRACT -Objective: To report a Brazilian series of spontaneous cervical arterial dissections, risk factors, warning symptoms, clinical manifestations, diagnostic tests, treatment and prognosis. Method: We performed the retrospective analysis of clinical and neuroradiological records (MRI, A-MRI and Angiography) of patients with this diagnosis who were evaluated in a tertiary hospital for the period of 1997-2003. Results: 48 patients (24 men) with median age 37.9 years: 26 patients with unilateral internal carotid dissection (ICAD), 15 with unilateral vertebral artery dissection (VAD) and 7 with multivessel dissections. All patients presented neurological deficits. Hypertension, smoking and dyslipidemia were the main risk factors. More than 80% of patients presented at least one initial symptom, most of them temporoparietal headache. 44% of patients with VAD and only 3.4% of patients with ICAD had neck pain. The median interval between the onset of symptom and the appearance of neurological deficit was 5.4 days for ICAD and 13.5 days for VAD. Five patients with ICAD presented preceding TIA. Angiography was performed in...

Spontaneous carotid dissection with hypoglossal nerve palsy as residual deficit: the importance of magnetic resonance evaluation

“…Treatment involves antithrombotic or antiplatelet therapy, as was the case in our patient. Systemic anticoagulation may bring some benefits by reducing the risk of embolization and aiding intimal healing, but there is no conclusive evidence in current literature for one choice over the other [1][2][3]10 . referenceS…”

“…It is an important cause of stroke in young patients, representing 10 to 25% of the cases 1,2 . Most patients affected are in the fifth decade of life 2,3 .…”

“…It is an important cause of stroke in young patients, representing 10 to 25% of the cases 1,2 . Most patients affected are in the fifth decade of life 2,3 . It is not definitely established whether the cardiovascular risk factors are important in spontaneous carotid dissection; however, tobacco use, migraine and respiratory tract infections have been shown to be relevant in different studies [1][2][3][4] .…”

“…Most patients affected are in the fifth decade of life 2,3 . It is not definitely established whether the cardiovascular risk factors are important in spontaneous carotid dissection; however, tobacco use, migraine and respiratory tract infections have been shown to be relevant in different studies [1][2][3][4] . In spite of the term spontaneous dissection, minor precipitating events, such as rotation or hyperextension of the neck, are frequently found 1,5 .…”

“…Few patients present the classical triad of headache, ischemic stroke and Horner syndrome. Cranial nerve palsy is found in about 12% of the cases, but unusually it is the sole manifestation [1][2][3] . We report a case of carotid artery dissection presenting as lower cranial nerve palsy and headache.…”