Profiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review

Sufang Xue,1,* Yi Yang,1,* Pengyu Li,2 Ping Liu,3 Xiangying Du,2 Xin Ma1 1Neurology Department of Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Radiology Department of Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of...

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Autores principales:	Xue S, Yang Y, Li P, Liu P, Du X, Ma X
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	vertebral artery dissection craniovertebral junction malformation clinical and imaging features treatment prognosis Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/8046a09bf3504905a7f72e1858827a9f
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spelling	oai:doaj.org-article:8046a09bf3504905a7f72e1858827a9f2021-12-02T12:09:10ZProfiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review1178-2021https://doaj.org/article/8046a09bf3504905a7f72e1858827a9f2020-10-01T00:00:00Zhttps://www.dovepress.com/profiles-of-vertebral-artery-dissection-with-congenital-craniovertebra-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Sufang Xue,1,* Yi Yang,1,* Pengyu Li,2 Ping Liu,3 Xiangying Du,2 Xin Ma1 1Neurology Department of Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Radiology Department of Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Neurology Department of Hejian People’s Hospital, Cangzhou, Hebei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xin MaNeurology Department of Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China, Tel +86-135-0139-0691Email maxin118@hotmail.comObjective: Vertebral artery dissection (VAD) combined with congenital craniovertebral junction malformation (CVJM) is rare. This study aimed to analyze the etiology, clinical and imaging features, treatment, and prognosis of VAD with CVJM.Methods: Four new cases of VAD with congenital CVJM and 28 similar cases found in the literature were included. Detailed clinical data from all cases were retrospectively analyzed.Results: A total of 32 patients (28 men, four women; mean age 19.01± 12.53 years) were included. Seventeen of 32 cases (53.1%) had had multiple ischemic episodes. The most common neurological symptoms were limb numbness/weakness (20/32), ataxia (15/32), and dizziness/vertigo (12/32). In sum, 31 of 32 cases had multiple infarcts scattered throughout the posterior circulation area on cranial computed tomography or resonance imaging. Dissection had occurred in the V3 segment of the VA in 29/31 cases (93.5%). The most common congenital CVJMs were atlantoaxial dislocation and atlantoaxial subluxation (found in 20/32 cases [62.5%]), while 27/32 cases (84.3%) had multiple combined abnormalities. Seven of eleven cases (63.6%) with initial antiplatelet treatment and one of eleven (9.1%) with initial anticoagulation treatment experienced stoke recurrence. Fusion or vertebral fixation was performed in 16 patients and aneurysm resection in one patient. There was no reported recurrence after surgery in 13 patients with follow-up data.Conclusion: Underlying CVJM is a rare but overlooked etiology in VAD, and is prone to induce recurrent ischemic stroke. Patients with VAD, especially that localized in the V3 segment, should be examined for CVJM. Timely assessment is critical for determining the specific cause and to provide targeted intervention.Keywords: vertebral artery dissection, craniovertebral junction malformation, clinical and imaging features, treatment, prognosisXue SYang YLi PLiu PDu XMa XDove Medical Pressarticlevertebral artery dissectioncraniovertebral junction malformationclinical and imaging featurestreatmentprognosisNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 16, Pp 2429-2447 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	vertebral artery dissection craniovertebral junction malformation clinical and imaging features treatment prognosis Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	vertebral artery dissection craniovertebral junction malformation clinical and imaging features treatment prognosis Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Xue S Yang Y Li P Liu P Du X Ma X Profiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review
description	Sufang Xue,1,* Yi Yang,1,* Pengyu Li,2 Ping Liu,3 Xiangying Du,2 Xin Ma1 1Neurology Department of Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Radiology Department of Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Neurology Department of Hejian People’s Hospital, Cangzhou, Hebei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xin MaNeurology Department of Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China, Tel +86-135-0139-0691Email maxin118@hotmail.comObjective: Vertebral artery dissection (VAD) combined with congenital craniovertebral junction malformation (CVJM) is rare. This study aimed to analyze the etiology, clinical and imaging features, treatment, and prognosis of VAD with CVJM.Methods: Four new cases of VAD with congenital CVJM and 28 similar cases found in the literature were included. Detailed clinical data from all cases were retrospectively analyzed.Results: A total of 32 patients (28 men, four women; mean age 19.01± 12.53 years) were included. Seventeen of 32 cases (53.1%) had had multiple ischemic episodes. The most common neurological symptoms were limb numbness/weakness (20/32), ataxia (15/32), and dizziness/vertigo (12/32). In sum, 31 of 32 cases had multiple infarcts scattered throughout the posterior circulation area on cranial computed tomography or resonance imaging. Dissection had occurred in the V3 segment of the VA in 29/31 cases (93.5%). The most common congenital CVJMs were atlantoaxial dislocation and atlantoaxial subluxation (found in 20/32 cases [62.5%]), while 27/32 cases (84.3%) had multiple combined abnormalities. Seven of eleven cases (63.6%) with initial antiplatelet treatment and one of eleven (9.1%) with initial anticoagulation treatment experienced stoke recurrence. Fusion or vertebral fixation was performed in 16 patients and aneurysm resection in one patient. There was no reported recurrence after surgery in 13 patients with follow-up data.Conclusion: Underlying CVJM is a rare but overlooked etiology in VAD, and is prone to induce recurrent ischemic stroke. Patients with VAD, especially that localized in the V3 segment, should be examined for CVJM. Timely assessment is critical for determining the specific cause and to provide targeted intervention.Keywords: vertebral artery dissection, craniovertebral junction malformation, clinical and imaging features, treatment, prognosis
format	article
author	Xue S Yang Y Li P Liu P Du X Ma X
author_facet	Xue S Yang Y Li P Liu P Du X Ma X
author_sort	Xue S
title	Profiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review
title_short	Profiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review
title_full	Profiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review
title_fullStr	Profiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review
title_full_unstemmed	Profiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review
title_sort	profiles of vertebral artery dissection with congenital craniovertebral junction malformation: four new cases and a literature review
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/8046a09bf3504905a7f72e1858827a9f
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Profiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review

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