Institute for Stroke and Dementia Research, Ludwig-Maximilians- University, Munich, Germany.
Cephalalgia. 2013 May;33(7):491-5. doi: 10.1177/0333102413479836. Epub 2013 Mar 8.
The pathophysiological basis of reversible cerebral vasoconstriction syndrome is poorly understood but carotid artery dissection has been discussed as a rare possible cause. So far, only single cases of unilateral carotid artery dissection and reversible cerebral vasoconstriction syndrome have been reported.
Here, we describe the case of a 54-year old patient presenting to the emergency department with right hemiparesis, hypaesthesia and dysarthria. Furthermore, he reported two episodes of thunderclap headache after autosexual activity. Cerebral imaging showed ischaemic infarcts, slight cortical subarachnoid haemorrhage, bilateral carotid artery dissection and fluctuating intracranial vessel irregularities, compatible with reversible cerebral vasoconstriction syndrome. An extensive diagnostic work-up was normal. No typical trigger factors of reversible cerebral vasoconstriction syndrome could be found. The patient received intravenous heparin and the calcium channel blocker nimodipine. Follow-up imaging revealed no vessel irregularities, the left internal carotid artery was still occluded.
This case supports the assumption that carotid artery dissection should be considered as a potential trigger of reversible cerebral vasoconstriction syndrome, possibly by altering sympathetic vascular tone.
可逆性脑血管收缩综合征的病理生理基础尚不清楚，但颈动脉夹层已被讨论为一种罕见的可能病因。到目前为止，仅报道过单侧颈动脉夹层和可逆性脑血管收缩综合征的单个病例。
我们在此报告一例 54 岁男性患者，因右侧偏瘫、感觉减退和构音障碍就诊于急诊科。此外，他在自慰后发生了两次霹雳性头痛。脑部影像学检查显示缺血性梗死、轻微皮质下蛛网膜下腔出血、双侧颈动脉夹层和颅内血管不规则波动，符合可逆性脑血管收缩综合征。广泛的诊断检查均正常。未发现可逆性脑血管收缩综合征的典型触发因素。患者接受了静脉肝素和钙通道阻滞剂尼莫地平治疗。随访影像学检查显示血管无异常，左侧颈内动脉仍闭塞。
该病例支持颈动脉夹层可能是可逆性脑血管收缩综合征的潜在触发因素的假设，可能是通过改变交感血管张力。
