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Neurological Surgery No Shinkei Geka Volume 46, Issue 4 （April 2018）

Neurological Surgery 脳神経外科 46巻4号（2018年4月発行）

Japanese English

研究

疼痛のみで発症した椎骨動脈解離の臨床像 Characteristics of Headache and Neck Pain in Spontaneous Vertebral Artery Dissections 堀恵美子 ¹ , 堀聡 ¹ , 岡本宗司 ¹ , 柴田孝 ¹ , 梅村公子 ¹ , 久保道也 ¹ , 古井英介 ² , 堀江幸男 ¹ , 黒田敏 ³ Emiko HORI ¹ , Satoshi HORI ¹ , Soshi OKAMOTO ¹ , Takashi SHIBATA ¹ , Kimiko UMEMURA OYA ¹ , Michiya KUBO ¹ , Eisuke FURUI ² , Yukio HORIE ¹ , Satoshi KURODA ³ ¹富山県済生会富山病院脳卒中センター脳神経外科 ²富山県済生会富山病院脳卒中センター脳卒中内科 ³富山大学医学部脳神経外科 ¹Department of Neurosurgery, Saiseikai Toyama Hospital ²Department of Stroke Neurology, Saiseikai Toyama Hospital ³Department of Neurosurgery, Faculty of Medicine, University of Toyama キーワード： vertebral artery dissection , headache , neck pain , diagnosis Keyword: vertebral artery dissection , headache , neck pain , diagnosis pp.295-299

発行日 2018年4月10日 Published Date 2018/4/10

DOI https://doi.org/10.11477/mf.1436203719

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Ⅰ．はじめに

　椎骨動脈解離に伴う疼痛は，急性発症で一側性の激しい痛みが特徴的であるとされている^11,12)．しかし，近年の画像診断の進歩に伴い，日常臨床においてその診断率が高まるとともに，疼痛の性状が必ずしも激しい痛みでない症例に遭遇することがある^16,18)．

　今回，われわれは，疼痛発症の頭蓋内椎骨動脈解離の初期診断率をさらに高めるべく，その臨床像を再検討したので報告する．

　PURPOSE:Sudden onset severe occipital/nuchal pain is believed to be a typical symptom of vertebral artery dissection（VAD). However, recent developments in diagnostic imaging have suggested that VAD is not always associated with such pain. This study aimed to analyze the clinical features of initial symptoms in patients with VAD.

　METHODS:In total, this study included 29 consecutive patients who were referred to our hospital because of only headache and/or nuchal pain due to VAD between 2011 and 2016. In this study, their clinical features were precisely assessed, including the pain location, onset pattern, duration, intensity, disease period, diagnosis modality, and prognosis. Both MRI and MRA were performed for all subjects. Cerebral angiography and thin-slice T1-weighted MRI were additionally performed in selected cases.

　RESULTS:Of the 29 patients, 23 presented with occipital headache and/or nuchal pain. The pain was persistent in 26/29 and ipsilateral in 29/29. However, only 16/29 reported a typical sudden onset. Only 12/29 complained of severe pain, while the other 17/29 presented with dull pain. The mean interval between onset and hospitalization was 7.4 days（0 to 30 days）and the mean interval between hospitalization and diagnosis was 3.9 days（0 to 21 days). Intramural hematoma was identified in 21/29 patients using thin-slice T1-weighted MRI.

　CONCLUSION:Only 55% of patients with VAD demonstrate typical occipital/nuchal pain with sudden onset. Both MRI and MRA should be indicated for patients who complain of persistent, unilateral pain in the occipital/nuchal regions to prevent VAD being missed during diagnosis.