Department of Neurosurgery, University of Cincinnati College of Medicine and Mayfield Clinic, Cincinnati, Ohio 45267-0515, USA.
Pediatr Neurol. 2013 Feb;48(2):139-42. doi: 10.1016/j.pediatrneurol.2012.10.005.
Reversible cerebral vasoconstriction syndrome is a rare cause of headache and stroke in the pediatric population. Reversible vasoconstriction is reported in a 19-month-old girl with retinoblastoma who underwent selective ophthalmic artery infusion chemotherapy with melphalan. Procedure-related cerebral vasoconstriction was specifically triggered during coadministration of adjunctive medications, which included mydriatic eye drops containing phenylephrine, intranasal oxymetazoline, nebulized albuterol, intravenous hydrocortisone, and intravenous diphenhydramine. The course of cerebral vasospasm, which began with a severe hypertensive surge and resolved spontaneously within hours of blood pressure normalization, was documented by angiography in real time. Subsequent brain magnetic resonance imaging showed no evidence of perfusion abnormality, cerebral infarction, or cerebral hemorrhage, and the patient was discharged home without any neurologic sequelae. In this report, we highlight the potential risk of reversible cerebral vasoconstriction in children administered vasoactive drugs and discuss its relevance during treatment of retinoblastoma by intraarterial chemotherapy.
可逆性脑血管收缩综合征是儿科人群头痛和卒中的一个罕见病因。报道了一例 19 月龄患有视网膜母细胞瘤的女孩，在接受马来酸麦考酚酯选择性眼动脉灌注化疗时出现可逆性血管收缩。在联合使用辅助药物时，特别是在使用含有苯肾上腺素的散瞳滴眼剂、鼻内羟甲唑啉、雾化沙丁胺醇、静脉注射氢化可的松和静脉注射苯海拉明时，会引发与操作相关的脑血管收缩。实时血管造影记录了始于严重高血压骤升并在血压正常化后数小时内自发缓解的脑血管痉挛过程。随后的脑磁共振成像显示无灌注异常、脑梗死或脑出血证据，患者无任何神经后遗症出院回家。在本报告中，我们强调了血管活性药物给药的儿童发生可逆性脑血管收缩的潜在风险，并讨论了其在经动脉内化疗治疗视网膜母细胞瘤时的相关性。
