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Clinical picture of intracranial non-traumatic dissecting aneurysm
1Department of Neurological Surgery, Chiba University School of Medicine, Japan. yamaura@med.m.chiba-u.ac.jp
Insights
Non-traumatic intracranial arterial dissection is a significant cause of stroke in young adults. This Japanese study highlights its higher incidence in the vertebrobasilar system and links subarachnoid hemorrhage to increased recurrence rates.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Non-traumatic intracranial arterial dissection is a recognized cause of stroke, particularly in younger populations.
- Prevalence and specific clinical features in Asian populations remain less understood compared to Western countries.
Purpose of the Study:
- To investigate the natural history and treatment of intracranial dissecting aneurysms in Japan.
- To identify epidemiological and clinical characteristics of this condition within a Japanese cohort.
Main Methods:
- A nationwide study conducted in Japan in 1996.
- Analysis of clinical data, radiological findings, treatment modalities, and patient outcomes.
Main Results:
- Symptomatic dissection was more common in the vertebrobasilar system than the carotid system.
- The mean patient age was 51.3 years, with carotid lesions occurring in younger patients (mean 43.8 years).
- Subarachnoid hemorrhage occurred in 58% of patients, associated with higher recurrence rates (14%) and more frequent surgical intervention (61%).
Conclusions:
- Intracranial arterial dissection in Japan shows distinct epidemiological features, with a predilection for the vertebrobasilar system.
- Subarachnoid hemorrhage is a significant prognostic factor, influencing recurrence and treatment decisions.
- Overall good recovery was observed in 64% of patients, with better outcomes in those without hemorrhage.
Abstract:
Non-traumatic intracranial arterial dissection has been accepted as a unique entity of 'cerebral infarction in otherwise healthy young adults', and is particularly prevalent in Western countries. A recent data collection and analysis have revealed additional clinical features. The nationwide study in Japan conducted in 1996 has provided new information on the natural history and current treatment of intracranial dissecting aneurysms in Japan. The incidence of symptomatic dissection was found to be much higher in the vertebrobasilar system than in the carotid system. The mean age of the patients was 51.3 years. Patients with carotid lesions were younger (mean 43.8 years). The male/female ratio was 2: 1. Fifty-eight percent of patients presented with subarachnoid hemorrhage. Recurrence was more frequent in patients with subarachnoid hemorrhage (14%) than in patients with no hemorrhage (4.2%). Common radiological findings were dilatation, 'pearl and string' sign and narrowing of the affected artery. Surgical treatment involved a variety of procedures including proximal occlusion, entrapment, wrapping and endovascular embolization. Patients with subarachnoid hemorrhage (61%) underwent surgical treatment more frequently than patients with no hemorrhage (17%). Good recovery was achieved in 64% of all patients. Outcome was better in patients with no subarachnoid hemorrhage compared with those with hemorrhage.