Systematic review of postpartum and pregnancy-related cervical artery dissection

Cervical artery dissection (CeAD) is responsible of one fifth of cases of ischemic stroke, but is uncommon during pregnancy or the early postpartum period and evidence is derived from published case reports and case series. This systematic review with a prospectively registered protocol was conducted to study the clinical presentation, management and prognosis of this condition. Ovid-Medline, PubMed Central, and CINAHL were searched without language restriction. Fifty-seven articles (50 case reports and seven case series) reporting on 77 patients were included. The mean age was 33.7 years. The main possible risk factors identified were migraine, hyperlipidemia, connective tissue disorders, preeclampsia and eclampsia, HELLP syndrome and prolonged second stage of labor. Headache was the most frequent symptom, followed by neck pain. Acute medical treatments included anticoagulation, antiplatelets, and endovascular therapy. No patients received thrombolysis. The overall prognosis was good with 77.8% of patients making full clinical recovery. Cervical artery dissection is a rare, but an important complication of pregnancy and puerperium. Diagnosis requires a high index of suspicion. The strong association with hypertensive and connective tissue disorders requires further research

颈动脉夹层（Cervical artery dissection, CeAD）占缺血性卒中病例的五分之一，但在妊娠或产后早期较为罕见，现有证据均来自已发表的个案报告与病例系列研究。本项采用前瞻性注册方案的系统综述旨在探讨该疾病的临床表现、诊疗方案与预后情况。研究未设置语言限制，对Ovid-Medline、PubMed Central及CINAHL数据库进行了检索。最终纳入57篇文献（含50篇个案报告与7篇病例系列研究），共涉及77例患者。患者平均年龄为33.7岁。已识别的主要潜在危险因素包括偏头痛、高脂血症、结缔组织病、子痫前期与子痫、HELLP综合征以及第二产程延长。头痛为最常见的症状，其次为颈部疼痛。急性期治疗手段包括抗凝治疗、抗血小板治疗与血管内治疗，无患者接受溶栓治疗。总体预后良好，77.8%的患者实现了完全临床康复。颈动脉夹层是妊娠与产褥期罕见但重要的并发症，临床诊断需高度警惕。该疾病与高血压及结缔组织病存在密切关联，相关研究仍有待进一步开展。