Acute hemicranial pain accompanied with a pearl and string type dissection of intracranial vertebral artery: Consideration for the time when to finish the medical observation.

Autor:	Jeon YS; Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Republic of Korea., Cho J; Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Republic of Korea., Park JJ; Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea., Roh HG; Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea., Chun YI; Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Republic of Korea.
Jazyk:	angličtina
Zdroj:	Medicine [Medicine (Baltimore)] 2022 Dec 09; Vol. 101 (49), pp. e32008.
DOI:	10.1097/MD.0000000000032008
Abstrakt:	The International Classification of Headache Disorder (ICHD) clearly guides the suspicion of intracranial vertebral artery dissection (ICVAD) in headache patients, but guidelines on how observational or imaging studies should be performed to detect dangerous progression early are unclear. Fifty-six cases with pearl and string type intracranial vertebral artery dissection were divided into 3 groups: 39 in the headache group, 6 in the infarction group, and 11 in the hemorrhagic group. Clinical and angiographic data were analyzed and compared. Most headaches resolved within 2 weeks and did not exceed 8 weeks. Of the 33 patients (84.6%) who underwent continuous follow-up imaging, 18 (54.5%) returned to normal, but 3 (9%) had deteriorated. All the patients survived without subsequent bleeding or infarction. Image changes started before 3rd month and ended after 6 to 7 months. In acute ICVADs, image changes occur at the same time as the headache resolves and continue for several months after the headache has subsided. Since the dissection is likely to worsen even after the headache disappears, the image changes continue over several months, and prediction of rupture of unruptured ICVAD is unpredictable, it is desirable to conduct continuous imaging studies regularly after the initiation of dissection until stabilization is confirmed. Competing Interests: The authors have no funding and conflicts of interest to disclose. (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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