与慢性寰枢椎结构异常相关的椎动脉夹层及PICA供血区卒中：一例病例报告

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中文摘要

背景： 上颈椎结构性疾病可改变椎动脉的生物力学，尽管仅凭解剖学上的邻近关系无法确立机械性作用。我们描述了一位患有血清阴性炎性关节炎和慢性寰枢椎异常的老年女性，她尽管美国国立卫生研究院卒中量表（NIHSS）评分为0，却突发眩晕、恶心和无法行走。方法：计算机断层扫描血管造影（CTA）显示左侧V3段椎动脉夹层，并在颅椎交界处伴有假性动脉瘤样扩张。磁共振成像（MRI）显示左侧小脑后下动脉（PICA）供血区优势性急性梗死。颈椎影像显示寰枢椎畸形、齿状突周围血管翳样组织，以及与受累V3段相邻的C1弓异常。超声心动图和住院期间遥测未发现栓塞来源。结果：C1-C2异常与V3病变的解剖学共定位，连同同侧PICA梗死，提示可能存在机械性因素参与夹层，随后发生动脉到动脉的血栓栓塞至小脑。未证实动态压迫；自发性夹层、颅内动脉粥样硬化和隐匿性栓塞仍是替代或附加机制。患者接受了双联抗血小板治疗，随后接受阿司匹林、他汀类药物治疗和康复。结论：本病例强调了NIHSS在后循环卒中中的局限性，以及当V3病变发生在上颈椎结构性疾病附近时评估颅椎交界处的重要性。

英文摘要

Upper cervical structural disease can alter vertebral artery biomechanics, although a mechanical contribution cannot be established by anatomical proximity alone. We describe an older woman with seronegative inflammatory arthritis and chronic atlantoaxial abnormality who developed abrupt vertigo, nausea, and inability to walk despite a National Institutes of Health Stroke Scale (NIHSS) score of 0. Computed tomography angiography (CTA) demonstrated left V3 vertebral artery dissection with pseudoaneurysmal dilation at the craniovertebral junction. Magnetic resonance imaging (MRI) showed a dominant acute left posterior inferior cerebellar artery (PICA)-territory infarction. Cervical imaging demonstrated atlantoaxial deformity, pannus-like peri-odontoid tissue, and a C1 arch abnormality adjacent to the affected V3 segment. Echocardiography and inpatient telemetry did not identify an embolic source. Anatomical colocalization of the C1-C2 abnormality and V3 lesion, together with the ipsilateral PICA infarction, suggests a possible mechanical contribution to the dissection, with subsequent artery-to-artery thromboembolism to the cerebellum. Dynamic compression was not demonstrated; spontaneous dissection, intracranial atherosclerosis, and occult embolism remain alternative or additional mechanisms. The patient received dual antiplatelet therapy followed by aspirin, statin therapy, and rehabilitation. This case emphasizes the limitations of the NIHSS in posterior circulation stroke and the importance of evaluating the craniovertebral junction when a V3 lesion occurs near upper cervical structural disease.