Comparison of Clinical and Anatomical Differences of Vertebral Artery Dissection between Minor Trauma and Non-trauma Causes

경증 외상관련 척추동맥박리의 임상양상 및 해부학적 위치 비교

  • Chong, Yeon Hee (Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center) ;
  • Ahn, Ji Yun (Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center) ;
  • Oh, Bum Jin (Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center) ;
  • Kim, Won (Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center) ;
  • Lim, Kyoung Soo (Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center)
  • 정연희 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 안지윤 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 오범진 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 김원 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 임경수 (울산대학교 의과대학 서울아산병원 응급의학교실)
  • Received : 2007.10.25
  • Accepted : 2007.11.29
  • Published : 2007.12.30

Abstract

Purpose: This study aimed to find any difference in the clinical or the anatomical findings of vertebral artery dissection (VAD) between the trauma and the non-trauma groups. Methods: We retrospectively reviewed the clinical data and radiologic images of VAD patients. We compared data on symptoms, neurologic deficit, National institutes of health stroke scale (NIHSS) at admission, Rankin score (RS) at admission and discharge, and radiological findings including anatomical features, between the trauma and the non-trauma groups. Results: From January 1997 to May 2006, 42 patients were enrolled and 13 patients (31%) had a history of earlier trauma. Focal neurologic deficit (trauma group 11/13 vs. non-trauma group 11/29), cerebral stroke (10/13 vs. 9/29), and extradural lesions of dissection (6/13 vs. 3/28) were more common in the trauma group than non-trauma group (p=0.007, p=0.017, p=0.018, respectively) and NIHSS at admission and discharge were significantly higher (p=0.012, p=0.001, respectively). Dissecting aneurysms were less frequent in the trauma group (2/13 vs. 19/29, p=0.006). Subarachnoid hemorrhage and unfavorable prognostic value (Rankin score at discharge ${\geq}$ 2) showed no differences between the groups (p=0.540, p=0.267, respectively). Conclusion: In VAD patients after trauma, focal neurologic deficit due to ischemic stroke and a steno-occlusive pattern are more frequent than they are in non-trauma patients. The location of dissection was most frequent at the extradural vertebral artery in the trauma group. NIHSS was higher in the trauma groups but the incidence of an unfavorable prognostic value (RS ${\geq}$ 2) was not significantly different between the groups.

Keywords

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