Calabrese Leonard H, Dodick David W, Schwedt Todd J, Singhal Aneesh B
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Ann Intern Med. 2007 Jan 2;146(1):34-44. doi: 10.7326/0003-4819-146-1-200701020-00007.
Reversible cerebral vasoconstriction syndromes (RCVS) comprise a group of diverse conditions, all characterized by reversible multifocal narrowing of the cerebral arteries heralded by sudden (thunderclap), severe headaches with or without associated neurologic deficits. Reversible cerebral vasoconstriction syndromes are clinically important because they affect young persons and can be complicated by ischemic or hemorrhagic strokes. The differential diagnosis of RCVS includes conditions associated with thunderclap headache and conditions that cause irreversible or progressive cerebral artery narrowing, such as intracranial atherosclerosis and cerebral vasculitis. Misdiagnosis as primary cerebral vasculitis and aneurysmal subarachnoid hemorrhage is common because of overlapping clinical and angiographic features. However, unlike these more ominous conditions, RCVS is usually self-limited: Resolution of headaches and vasoconstriction occurs over a period of days to weeks. In this review, we describe our current understanding of RCVS; summarize its key clinical, laboratory, and imaging features; and discuss strategies for diagnostic evaluation and treatment.
可逆性脑血管收缩综合征（RCVS）包括一组不同的病症，其共同特征是脑动脉出现可逆性多灶性狭窄，起病突然（霹雳样），伴有或不伴有相关神经功能缺损的严重头痛。可逆性脑血管收缩综合征在临床上具有重要意义，因为它影响年轻人，并且可能并发缺血性或出血性中风。RCVS的鉴别诊断包括与霹雳样头痛相关的病症以及导致不可逆或进行性脑动脉狭窄的病症，如颅内动脉粥样硬化和脑血管炎。由于临床和血管造影特征重叠，误诊为原发性脑血管炎和动脉瘤性蛛网膜下腔出血很常见。然而，与这些更严重的病症不同，RCVS通常是自限性的：头痛和血管收缩在数天至数周内消退。在本综述中，我们描述了目前对RCVS的认识；总结其关键的临床、实验室和影像学特征；并讨论诊断评估和治疗策略。
