Moustafa R R, Allen C M C, Baron J-C
University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0989. Epub 2009 Feb 2.
The Call-Fleming syndrome (CFS) comprises acute severe recurrent (thunderclap) headaches, occasional transient or fluctuating neurological abnormalities and reversible segmental cerebral vasoconstriction. It is a benign condition with an excellent prognosis, yet because it is often clinically and radiologically similar to a number of commonly encountered conditions, diagnostic difficulties may arise, leading to inappropriate, and even potentially harmful, investigative and therapeutic approaches. Three personal cases are presented to highlight the occurrence of subarachnoid haemorrhage (SAH) as part of CFS. In two patients with a positive CT head, SAH involved the sulci in the upper cerebral convexity, an unusual location in aneurysmal SAH. SAH is not an uncommon feature of CFS, occurring in approximately 25% of reported cases, and may pose a diagnostic challenge. CFS has a relatively characteristic spectrum of features, allowing a confident diagnosis in most cases, even when atypical features such as SAH are present. Recognising the spectrum of abnormalities seen in CFS, including particularly SAH, allows a sound approach to a safe diagnosis.
卡尔-弗莱明综合征（CFS）包括急性重度复发性（霹雳样）头痛、偶尔出现的短暂性或波动性神经功能异常以及可逆性节段性脑血管收缩。这是一种良性疾病，预后良好，但由于其在临床和影像学上常与一些常见疾病相似，可能会出现诊断困难，导致不恰当甚至可能有害的检查和治疗方法。本文介绍三例个人病例，以突出蛛网膜下腔出血（SAH）作为CFS一部分的发生情况。在两名头颅CT检查呈阳性的患者中，SAH累及大脑上凸面的脑沟，这在动脉瘤性SAH中是不寻常的位置。SAH并非CFS的罕见特征，在约25%的报告病例中出现，可能构成诊断挑战。CFS具有相对特征性的一系列表现，即使存在SAH等非典型特征，在大多数情况下也能做出可靠诊断。认识到CFS中所见的一系列异常，特别是SAH，有助于采取合理方法进行安全诊断。
