| Background and ObjectivesCervicocerebral artery dissection(CAD),which corresponds with a haematoma in the wall of a cervical or an intracranial artery is an acute cerebrovascular disease occurring at any age,but more common between 35 and 50 years old,and it may progress to an ischemic event,such as ischemia and infarction of brain tissue.Reports showed that in all ischemic stroke patients,CAD accounts for 2%,but up to 25% in people under 55 years.Its clinical features include headache,neck pain,Horner’s syndrome,subarachnoid hemorrhage,cranial nerve palsy and cerebral ischemia.In most cases,headache and neck pain may be the initial symptom before the ischemic stroke.However,due to the fact that early features of CAD can mimic a painful musculoskeletal presentation,trigeminal neuralgia-like pain or migraine,the clinical diagnosis may be difficult when clear neurological features are not present.Previous studies reported that ischemic stroke patients with headache accounting for 16% to 27% of all ischemic stroke patients and mainly determined by the location and etiology of ischemic stroke,had a better prognosis than those without.However,the ischemic stroke caused by CAD often needed specific endovascular treatment to prevent the progression of the disease.Therefore,it is important to screen ischemic stroke patients with CAD.At present,there were few studies on the characteristics of head and neck pain caused by CAD.This study was performed to analyze the characteristics and relative factors of headache and neck pain in CAD patients;By analyzing the difference of headahce and neck pain in ischemic stroke patients with CAD and patients without CAD,we summarized characteristics of the pain in ischemic stroke patients secondary to CAD.MethodsA total of 146 consecutive CAD patients without subarachnoid hemorrhage diagnosed and treated in the Department of Neurology and Neurological Intervention of the First Affiliated Hospital of Zhengzhou University were observed and registered prospectively from 2010 to 2017.There were 60(60/146)cases who complained of headache and neck pain,and we analyzed the characteristics of pain according to their clinical features;For the 130(130/146)patients with complete clinical laboratory data,they were divided into two groups according to pain,and the relative factors of pain were analyzed;The clinical data of 81 patients with acute ischemic stroke in 146 patients and 84 consecutive ischemic stroke patients with large artery atherosclerosis(LAA)in Department of Neurology were compared.Those ischemic stroke patients complained of headache and neck pain were categorized into CAD group(34 cases)and LAA group(19 cases)according to the etiology of cerebral infarction.By analyzing the difference of headahce and neck pain in two groups,we summarized characteristics of the pain in ischemic stroke patients secondary to CAD.Results 1.The pain characteristics of 60 patients caused by CADThe headache and neck pain in 60 CAD patients was mostly acute onset(98.3%);70.6%(12/17)of patients with anterior circulation dissection and 88.4%(38/43)of patients with posterior circulation dissection complained of moderate to severe pain;41.2%(7/17)of patients with anterior circulation dissection had temporal pain,while 46.5%(20/43)of the patients with posterior circulation dissection had occipital pain;There were 23.5%(4/17)and 32.6%(14/43)of patients with anterior and posterior circulation dissection complained of throbbing pain,respectively,23.5%(4/17)and 20.9%(9/43)of patients with anterior and posterior circulation dissection complained of pulsating pain;The pain could occur in the ipsilateral(40.0%),bilateral(52.7%),or contralateral(7.3%)sites of the dissection.2.Analysis of pain relative factors in 130 CAD patients with complete clinical laboratory dataIn the 130 patients,there were 56 cases(43.1%)in the pain group,and 74 cases(56.9%)in the non-pain group.Multivariate logistic regression analysis showed that female gender(OR 4.01,95% CI 1.63–9.85,P=0.002),posterior circulation(OR 3.18,95% CI 1.39–7.28,P=0.006),history of headache(OR 4.72,95% CI 1.08–20.52,P=0.039),and low-density lipoprotein less than 1.8 mmol/L(OR 2.90,95% CI 1.15–7.34,P=0.025)were risk factors of the occurrence of the pain related to CAD.3.The pain characteristics of ischemic stroke patients caused by CADAs for patients in CAD group,the pain could be located in the ipsilateral(41.9%),bilateral(41.9%),or contralateral(16.1%)side of the dissected artery.In LAA group the pain caused by unilateral infarction could be located in the ipsilateral(25.0%),bilateral(58.3%),or contralateral(16.7%)side of the infarction,but it was often in both sides;When the dissected artery was involved in anterior circulation,55.6% of CAD patients had pain in temporal and when involved in posterior circulation,65.2% of CAD patients had pain in the occipital and neck;Patients with CAD had a higher prevalence of throbbing pain(30.0%),while pulsating pain(43.8%)was more common in LAA group;Patients often presented with severe pain(46.9%)in CAD group,while mild pain was more common(52.9%)in LAA group,with a significant difference(P=0.003).And there was a significant difference between the length(≥20mm)of the involved artery and severity of the pain(P=0.028)in CAD group.Conclusions1.Cervicocerebral artery dissection should be suspected when patients complain of unexplained,moderate to severe pain occurring acute.The nature of the pain mostly like throbbing and pulsating.2.The posterior circulation was more prone to pain than the anterior circulation.The anterior circulation dissection has a higher prevalence of temporal pain while posterior circulation dissection is typically more associated with occipital and neck pain.3.The ischemic stroke patients caused by CAD tend to suffer from headache and neck pain,which may be severe and throbbing.LAA patients were more likely to present with mild and pulsating pain.4.Female,posterior circulation dissection,LDL levels less than 1.8 mmol/L and the history of headache were risk factors of headache and neck pain duo to CAD. |
