Çiğdem DENİZ, Talip ASİL, ABDÜLKADİR TUNÇ

Extracranial and intracranial artery dissections: Experiences from a tertiary referral center

Background: Craniocervical artery dissection is an important cause of ischemic stroke especially in young and middleaged adults. In this study, we evaluated extracrainal and intracranial artery dissections in terms of etiologies, riskfactors, stroke severity and functional outcomes.Methods: A total of 29 patients who were diagnosed with ischemic stroke due to extracranial or intracranial arterydissections were enrolled to this study. The ischemic stroke diagnosis was confirmed with diffusion weightedmagnetic resonance imaging in all patients. Computed tomography angiography, magnetic resonance angiographyand digital subtraction angiography were used to demonstrate the dissection. Demographic findings, risk factors andpresence of trauma were evaluated. National Institute of Health Score Scale (NIHSS) was used for stroke severityassessment at disease onset. Functional outcomes were measured with Modified Rankin Scale (mRS) at the 3rdmonth.Results: Fifteen patients (51.72%) had carotid artery dissections while 12 patients (41.37%) had vertebral arterydissection (VAD), 1 (3.4%) had basilar artery dissection (BAD) and both VAD and BAD were seen in 1 patient (3.4%).Coagulopathy was detected in 12 patients (41.37%). Connective tissue disease was suspected in 3 patients (10.3%). In6 patients, dissections occured after trauma. Nineteen patients (65.51%) presented with somatosensory deficits. The3rd month mRS scores were in the range of 0-2 and no significant correlation was found in terms of risk factors,etiology and trauma history.Conclusion: Arterial dissection should be kept in mind for the clinical presentation of ischemic stroke in young adults.We think that better understanding of the risk factors, etiologies and clinical presentation of the dissections and earlydiagnosis-proper treatments might yield improved clinical outcomes.

Ekstrakraniyal ve intrakraniyal arter diseksiyonları: Bir üçüncü basamak merkezinden deneyimler

Amaç: Kraniyoservikal arter diseksiyonu özellikle genç ve orta yaşlı erişkinlerde iskemik inmenin önemli bir nedenidir. Bu çalışmada ekstrakrainal ve intrakranial arter diseksiyonlarını etiyolojiler, risk faktörleri, inme şiddeti ve fonksiyonel sonuçlar açısından değerlendirdik. Yöntemler: Bu çalışmaya, ekstrakraniyal veya intrakranial arter diseksiyonu nedeniyle iskemik inme teşhisi konan toplam 29 hasta alındı. İskemik inme tanısı tüm hastalarda difüzyon ağırlıklı manyetik rezonans görüntüleme ile doğrulandı. Diseksiyonu göstermek için bilgisayarlı tomografi anjiografi, manyetik rezonans anjiyografi ve dijital subtraksiyon anjiyografi kullanıldı. Demografik bulgular, risk faktörleri ve travma varlığı değerlendirildi. Hastalığın başlangıcında inme şiddet değerlendirmesi için National Institute of Health Score Scale (NIHSS) kullanıldı. Fonksiyonel sonuçlar 3. ayda Modifiye Rankin Skalası (mRS) ile ölçüldü. Bulgular: On beş hastada (%51,72) karotis arter diseksiyonu, 12 hastada (%41,37) vertebral arter diseksiyonu (VAD), 1'inde (%3,4) baziler arter diseksiyonu (BAD), 1'inde VAD ve BAD görüldü. (%3,4). Koagülopati 12 hastada (%41,37) saptandı. 3 hastada (%10,3) bağ dokusu hastalığı şüphesi vardı. 6 hastada travma sonrası disseksiyonlar meydana geldi. On dokuz hasta (%65,51) somatosensoryal defisitlerle başvurdu. 3 aylık mRS skorları 0-2 aralığındaydı ve risk faktörleri, etiyoloji ve travma öyküsü açısından anlamlı bir ilişki bulunmadı. Sonuç: Genç erişkinlerde iskemik inmenin ayırıcı tanısında arteriyel diseksiyon akılda tutulmalıdır. Risk faktörleri, etyoloji ve klinik bulguların daha iyi anlaşılması ve erken tanı- uygun tedavilerin klinik sonuçları iyileştirebileceği görüşündeyiz.

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