Aneurismas dissecantes intracranianos da circulação posterior relato de três casos e revisão da literatura

Dissecting aneurysms of the vertebrobasilar system: report of three cases and review of the literature

Resumos

As dissecções dos vasos cerebrais é causa rara de acidente vascular cerebral (quarta causa). Geralmente são de aparecimento espontâneo ou após trauma simples. É mais comprometido o sistema carotídeo e a evolução costuma ser benigna. As dissecções do sistema vértebro-basilar são menos comuns e a dissecção primária da artéria basilar é rara. As dissecções da circulação posterior têm sido diagnosticadas em proporção crescente, porém, seus mecanismos de lesão, o quadro clínico, os critérios de diagnóstico e o tratamento constituem problema da prática neurológica e a taxa de morbidade e mortalidade ainda é alta. Os autores abordam estes problemas e sugerem medidas que possam ser úteis no manuseio dessa patologia. Descrevem-se três casos de dissecção, dois da artéria vertebral e um da artéria basilar. É feito também levantamento de 80 casos já publicados, comparando-os aos três casos descritos.

sistema vértebro-basilar; aneurisma dissecante; acidente vascular encefálico; hemorragia subaracnóidea


Dissecting aneurysms of cerebral arteries are unusual causes of stroke. The carotid system is the commonest site of this pathology, the vertebral arteries are less involved and dissection of the basilar artery is tfare. The authors report three cases of arterial dissection of the vertebrobasilar system, two of the vertebral arteries and one of the basilar artery. An extensive review of the literature is presented. The clinical picture of dissection of vertebrobasilar system was inespecific but pain was a prominente symptom, though had not occurred in the site of the arteries involved. The pain was suggestive of subarachnoid hemorrhage. Associated or risk factors were mild trauma, migraine and high blood pressure. The angiographic findings were suggestive, however just the «double lumen» has been considered pathognomonic. The prognosis is variable. It was benign in case 3, left sequela in case 2, and case 1 rebleed fatally.

vertebrobasilar system; dissecting aneurysm; stroke; subarachnoid hemorrhage


Dissecting aneurysms of the vertebrobasilar system: report of three cases and review of the literature

Denise S. Diniz-CarneiroI; L. A. P. PortelaII; S. E. de Melo-SouzaIII

IMédica Residente em Neurologia. Instituto de Neurologia de Goiânia (ING)

IIRadiologista. Instituto de Neurologia de Goiânia (ING)

IIINeurologista e Coordenador de Ensino e Pesquisa. Instituto de Neurologia de Goiânia (ING)

RESUMO

As dissecções dos vasos cerebrais é causa rara de acidente vascular cerebral (quarta causa). Geralmente são de aparecimento espontâneo ou após trauma simples. É mais comprometido o sistema carotídeo e a evolução costuma ser benigna. As dissecções do sistema vértebro-basilar são menos comuns e a dissecção primária da artéria basilar é rara. As dissecções da circulação posterior têm sido diagnosticadas em proporção crescente, porém, seus mecanismos de lesão, o quadro clínico, os critérios de diagnóstico e o tratamento constituem problema da prática neurológica e a taxa de morbidade e mortalidade ainda é alta. Os autores abordam estes problemas e sugerem medidas que possam ser úteis no manuseio dessa patologia. Descrevem-se três casos de dissecção, dois da artéria vertebral e um da artéria basilar. É feito também levantamento de 80 casos já publicados, comparando-os aos três casos descritos.

Palavras-chave: sistema vértebro-basilar, aneurisma dissecante, acidente vascular encefálico, hemorragia subaracnóidea.

SUMMARY

Dissecting aneurysms of cerebral arteries are unusual causes of stroke. The carotid system is the commonest site of this pathology, the vertebral arteries are less involved and dissection of the basilar artery is tfare. The authors report three cases of arterial dissection of the vertebrobasilar system, two of the vertebral arteries and one of the basilar artery. An extensive review of the literature is presented. The clinical picture of dissection of vertebrobasilar system was inespecific but pain was a prominente symptom, though had not occurred in the site of the arteries involved. The pain was suggestive of subarachnoid hemorrhage. Associated or risk factors were mild trauma, migraine and high blood pressure. The angiographic findings were suggestive, however just the «double lumen» has been considered pathognomonic. The prognosis is variable. It was benign in case 3, left sequela in case 2, and case 1 rebleed fatally.

Key words: vertebrobasilar system, dissecting aneurysm, stroke, subarachnoid hemorrhage.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. Sebastião Eurico de Melo Souza — Instituto de Neurologia de Goiânia - Praça T-18, nº140 -Setor Bueno - 74610 Goiânia GO - Brasil.

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Datas de Publicação

  • Publicação nesta coleção
    22 Fev 2011
  • Data do Fascículo
    Set 1992
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