Institute of Clinical Medicine, Fu-Jen Catholic University, Taipei, Taiwan.
Ann Neurol. 2010 May;67(5):648-56. doi: 10.1002/ana.21951.
To investigate the evolution and clinical significance of vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral vasoconstriction syndromes (RCVS).
Patients with RCVS were recruited and followed up with MRA examinations until normalization of vasoconstriction or for 6 months. The vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0-<10%), 1 (10-<25%), 2 (25-<50%), 3 (50-<75%), and 4 (> or =75%). Subjects with at least 1 segment with a vasoconstriction score > or =2 were eligible for the study. Initial mean scores of single or combined arterial segments were used to predict ischemic complications.
Seventy-seven patients with RCVS (8 men/69 women; average age 47.7 +/- 11.6 years) finished the study with a total of 225 MRAs performed. The mean number of arterial segments involved was 5.3 +/- 3.0 in the initial MRA. Vasoconstriction scores reached their maximum 16.3 +/- 10.2 days after headache onset, close to the average timing of headache resolution (16.7 +/- 8.6 days). Vasoconstriction evolved in a parallel trend among different arterial segments. Seven (9.1%) patients developed posterior reversible encephalopathy syndromes (PRES). Six (7.8%) patients had ischemic stroke. A logistic regression model demonstrated that the M1-P2 combined score was associated with highest risk of PRES (odds ratio [OR], 11.6, p = 0.005) and ischemic stroke (OR, 3.4; p = 0.026).
MRA evaluation in patients with RCVS is valid. Vasoconstriction was pervasive and outlasted headache resolution. Vasoconstrictions in M1 and P2 are important determinants for PRES and ischemic stroke.
探讨可逆性脑血管收缩综合征（RCVS）患者磁共振血管造影（MRA）血管收缩的演变及其临床意义。
招募 RCVS 患者并进行 MRA 检查随访，直至血管收缩正常或随访 6 个月。采用 5 分制对大脑主要动脉节段（M1、M2、A1、A2、P1、P2 和基底动脉）的血管收缩严重程度进行评分：0（0-<10%）、1（10-<25%）、2（25-<50%）、3（50-<75%）和 4（>或=75%）。至少 1 个节段的血管收缩评分>或=2 的患者有资格进行研究。采用初始单节段或联合节段的平均评分来预测缺血性并发症。
77 例 RCVS 患者（8 名男性/69 名女性；平均年龄 47.7±11.6 岁）完成了这项研究，共进行了 225 次 MRA 检查。初始 MRA 时受累动脉节段的平均数量为 5.3±3.0。血管收缩评分在头痛发作后 16.3±10.2 天达到最大值，接近头痛缓解的平均时间（16.7±8.6 天）。不同动脉节段的血管收缩呈平行趋势演变。7 例（9.1%）患者发生后部可逆性脑病综合征（PRES）。6 例（7.8%）患者发生缺血性卒中。Logistic 回归模型显示，M1-P2 联合评分与 PRES （优势比 [OR]，11.6，p=0.005）和缺血性卒中（OR，3.4；p=0.026）的风险最高相关。
RCVS 患者的 MRA 评估是有效的。血管收缩广泛存在且持续时间超过头痛缓解时间。M1 和 P2 的血管收缩是 PRES 和缺血性卒中的重要决定因素。
