Emergency Headache Centre, Head and Neck Clinic, Lariboisière Hospital, Paris, France.
Lancet Neurol. 2012 Oct;11(10):906-17. doi: 10.1016/S1474-4422(12)70135-7.
Recurrent thunderclap headaches, seizures, strokes, and non-aneurysmal subarachnoid haemorrhage can all reveal reversible cerebral vasoconstriction syndrome. This increasingly recognised syndrome is characterised by severe headaches, with or without other symptoms, and segmental constriction of cerebral arteries that resolves within 3 months. Reversible cerebral vasoconstriction syndrome is supposedly due to a transient disturbance in the control of cerebrovascular tone. More than half the cases occur post partum or after exposure to adrenergic or serotonergic drugs. Manifestations have a uniphasic course, and vary from pure cephalalgic forms to rare catastrophic forms associated with several haemorrhagic and ischaemic strokes, brain oedema, and death. Diagnosis can be hampered by the dynamic nature of clinicoradiological features. Stroke can occur a few days after initial normal imaging, and cerebral vasoconstriction is at a maximum on angiograms 2-3 weeks after clinical onset. The calcium channel blocker nimodipine seems to reduce thunderclap headaches within 48 h of administration, but has no proven effect on haemorrhagic and ischaemic complications.
反复发作的霹雳头痛、癫痫发作、中风和非动脉瘤性蛛网膜下腔出血均可提示可逆性脑血管收缩综合征。这种日益被认识的综合征的特征是严重头痛，可伴有或不伴有其他症状，以及脑动脉节段性收缩，在 3 个月内缓解。可逆性脑血管收缩综合征可能是由于脑血管张力的短暂调节障碍所致。超过一半的病例发生在产后或接触肾上腺素能或 5-羟色胺能药物后。表现为单相病程，从单纯的头痛形式到罕见的与多处出血性和缺血性中风、脑水肿和死亡相关的灾难性形式不等。由于临床和影像学特征的动态性，诊断可能会受到阻碍。中风可在最初正常影像学检查后的几天内发生，而脑血管收缩在临床发病后 2-3 周的血管造影上达到最大值。钙通道阻滞剂尼莫地平似乎在给药后 48 小时内可减轻霹雳头痛，但对出血和缺血性并发症无明显疗效。
