可逆性脑血管收缩综合征临床及影像学特点

Clinical and radiological characteristics of reversible cerebral vasoconstriction syndrome

目的探讨可逆性脑血管收缩综合征（RCVS）的临床、影像学特点,以提高对该病的认识。方法总结3例RCVS患者的临床及影像学资料并复习相关文献。结果本组3例患者均以剧烈头痛为首发症状,其中1例伴有双下肢无力,1例伴视物模糊、右侧肢体轻偏瘫。TCD检查均提示不同血管不同程度的血流速度增快,头颅MRI及MRA检查提示部分血管痉挛,典型者呈＂串珠样＂改变;2例脑内有病灶。脑脊液等相关检查无特异性,经钙离子拮抗剂等治疗后临床症状逐渐消失,1～7个月超声影像学复查完全恢复正常,临床呈单相病程,预后良好。结论临床表现为＂雷击样、撕裂样＂头痛的患者伴或不伴有神经系统定位体征,影像学检查有血管痉挛表现,在排除其他疾病后应考虑RCVS的可能。

Objective To investigate the clinical and radiological characteristics of reversible cerebral vasoconstriction syndrome （RCVS） and to improve the understanding of this disease. Methods The clinical and radiological data of three patients with RCVS were retrospectively studied, and the relevant literature was reviewed. Results All the three patients presented with severe headache as the first symptom. One patient had weakness in both lower extremities and another had blurred vision and right hemiparesis. Tran- scranial Doppler revealed different levels of increase in speed of blood flow in cerebral vessels. Head magnetic resonance imaging （MRI） and magnetic resonance angiography indicated partial vasospasm, and beading appearance was observed in typical cases. Head MRI indicated intracephalic lesions in 2 patients. No abnormalities were observed in cerebrospinal fluid examination. The clinical symptoms disappeared after treatment with calcium antagonists. Ultrasound examination during 1 -7 months after treatment demonstra- ted complete recovery, suggesting that the disease was monophasic with good prognosis. Conclusions RCVS should be considered for patients with clinical features of bursting or lightning headache, with vasospasm in angiography, with or without nervous system signs after exclusion of other possibilities.