ИСТИНА

Aim: To study clinical features of neck pain and headache as the only manifestation of CeAD and to analyze neuroimaging data in these patients. Material and methods: We examined 192 patients with CeAD, verified by MRI/MRA (mean age 37.8±8.9 years, 88 females - 46%). Isolated cervical pain and/or headache was in 44 out of 192 patients (23%) (mean age 37.3±8.5 years, 36 females, 82%). Results: 30 out of 44 patients had VA dissection (VAD) (68%), 13 patients – internal carotid artery (ICA) dissection (ICAD) (30%), 1 female patient (2%) - a combination of ICAD and 2 VADs. Among patients with VAD there were more females (28 patients, 92%) than among ICAD patients (7 patients, 54%) (p<0.01), also VAD patients were younger then ICAD patients (37,1±9,1 vs 40,6±10,7 years, correspondingly). Bilateral dissection occurred more frequently in VAD (12 patients, 40%) than in ICAD (1 patient, 8%) (p=0.036). The total number of the dissected arteries in all 44 patients was 59. In most cases the dissection led to stenosis of the arterial lumen (93%), rarely - to dual lumen (5%) or occlusion (2%). Neck movements or physical exertion were the most frequent precipitating events for VAD (50%) and less frequently occurred in ICAD patients (23%) (p>0.05). Mild head trauma more often provoked ICAD (31%) than VAD (7%) (p= 0.04). The majority of patients had a combination of cervical pain and headache: VAD - 73%, ICAD - 46% (p>0.05). In addition, some VAD patients (47%) experienced pain in the arm or chest. Headache usually located on the side of the CeAD, anterior regions were more often involved (90%) in ICAD, whereas in VAD posterior regions (54%) or both posterior and anterior regions were involved (p<0.01). Neck pain in VAD patients had posterior localization, whereas in ICAD it located either on the anterior-lateral surface of the neck (56%) or on the posterior neck surface (44%) (p<0.01). Pain characteristics in most CeAD cases (75%) were: dull, pressing, gripping. Less frequently there was a combination of dull/throbbing and shooting pain. Pain intensity in most patients was moderate (30%) or severe (59%). In 53% of VAD patients pain has been increasing for several days, that has never been observed in ICAD patients. Maximum pain occurred during the first days (intensity could fluctuate) and in the majority of patients it completely disappeared in a month. Effect of analgesics in the acute period was either short or absent. Conclusion: Isolated pain in CeAD mostly occurs in women with VAD. Localization and course of the isolated pain in VAD and ICAD patients differ. The rarity of the arterial lumen occlusion suggests that intramural hematoma spreads towards the adventitia that could be due to the media weakness. Different embryonic origin of the ICA and VA probably underlies greater sensitivity of the VA wall to female sex hormones which, apparently, contributes to the development of the dysplasia and decreased elasticity of the arterial wall.