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Título

CEREBRAL AND CERVICAL ARTERY DISSECTION: 6 YEARS CLINICAL REVIEW

Resumo

INTRODUCTION: Arterial dissections are rare, despite being a common cause of stroke in the young; they occur upon lesion of the arterial wall, allowing formation of intramural hematoma. Aneurysm or hematoma formation and vessel dilatation may causes local and result in stenosis or occlusion, which can lead to cerebral ischemia. The optimal treatment of dissection remains a challenge due to limitations of rapid definitive diagnosis, low incidence, low recurrence rate, and marked variation in patient characteristics. OBJECTIVE: Evaluate the profiles and outcomes of patients with cerebral or cervical artery dissections, as well as the main symptoms and characteristics of the affected vessel, in patients treated in a Brazilian tertiary care hospital. METHODS: Retrospective, single-center observational study evaluating patients between January 2016 and December 2021. Data were collected from medical records; patient characteristics were analyzed (sex and age, initial symptoms, risk factors, history of trauma, pre-vious comorbidities). Imaging methods data include location of affected vessel and treatment. RESULTS: 87 patients were screened with intra or extracranial arterial dissection, with female predominance of 60.9% and mean age of 40.9 years. 28 cases occurred in the internal carotid artery, 17 on the left, with 53 in vertebral arteries, 22 on the left; a higher incidence of cases in the V2 and V3 segments (19 and 26, respectively) was seen; 31 cases were multisegmentar. The main symptoms were headache and neck pain, in 57 and 37 cases respectively; there were also clinical presentation with nausea (12 cases), dizziness (12), stroke (19), Horner's syndrome (9) and visual alterations (9). Only 36.7% of the cases had a history of trauma, 19.5% were using hormonal therapy, 8% had some coagulopathy after etiological investigation. All cases were initially investigated with AngioCT or AngioMRI and 55% underwent angiography to confirm the diagnosis. Patients were treated with warfarin; 4 patients were thrombolysed and 3 underwent angioplasty. CONCLUSIONS: Arterial dissections are an important cause of stroke in young patients and do not always evolve with a typical clinical manifestation, so they should be suspected with minor symptoms, such as headache and neck pain, in order to be treated early and prevent stroke. Treatment with anticoagulation seems to have good efficacy, but it is still the subject of several studies, given the advance in new therapies.

Palavras Chave

Cerebral Artery Dissection; Cervical Artery Dissection