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钝性脑血管损伤：机制、筛查及诊断性评估

Authors
Walter L Biffl, MD
Clay Cothren Burlew, MD
Ernest E Moore, MD
Section Editors
Heidi L Frankel, MD, FACS
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
黄齐兵, 副主任医师

引言

钝性颈动脉及椎动脉(vertebral artery,VA)损伤统称为钝性脑血管损伤，它们是罕见但具有潜在毁灭性的事件。钝性颈动脉损伤的死亡率为23%-28%，而48%-58%的存活者会遭受永久性严重神经功能障碍[1]。

在遭受钝性创伤的患者中，钝性脑血管损伤的总发生率较低。20世纪90年代早期的临床研究表明，这些损伤有被漏诊[2]。基于具体临床标准的筛查[动脉造影和计算机断层扫描血管造影(computed tomographic angiography, CTA)]已增加了对损伤的识别，并使钝性创伤患者中被报道的脑血管损伤的发生率增至大约1%[1,3-5]。此类损伤发生时常为双侧性。

钝性脑血管损伤的损伤机制、筛查及诊断将总结在此。钝性脑血管损伤的治疗将单独讨论。 (参见“钝性脑血管损伤：治疗和结局”)

穿透性脑血管损伤和自发性脑血管夹层的诊断和处理见其他专题。 (参见“颈部穿透伤的初始评估和处理”和“自发性脑动脉和颈动脉夹层：临床特征和诊断”)

脑血管解剖

脑的血液供应分为前循环和后循环，其分别来源于颈动脉和椎动脉。Willis环连接前循环和后循环，但仅有20%的个体的Willis环结构完全完整且对称[6]。侧支循环的解剖变异可帮助解释脑血管损伤患者的临床表现，也突显了当怀疑有损伤时对脑循环进行全面影像学检查的必要性。 (参见下文‘影像学评估’)

                      

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-16.
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