Ogura Aya, Suzuki Junichiro, Imai Kazunori, Nishida Suguru, Kato Takashi, Yasuda Takeshi, Ito Yasuhiro
Department of Neurology, Stroke Center, Toyota Memorial Hospital, Japan.
Rinsho Shinkeigaku. 2013;53(8):618-23. doi: 10.5692/clinicalneurol.53.618.
A 59-year-old woman presented with thunderclap headache. Cranial CT showed cortical subarachnoid hemorrhage (cSAH) at the right parietal lobe and cerebral angiography on day 5 revealed multiple cerebral arterial constriction, diagnosed as reversible cerebral vasoconstriction syndrome (RCVS). We could not detect vasoconstriction in MRA at the first examination on day 4, and vasoconstrictive finding appeared around Willis circle 8 days later. There was a temporal difference in a cephalalgic symptom and vasoconstrictive appearance. Clinical symptoms completely recovered and head CT, MRI/MRA findings were reversible after two months, reflecting a rather good RCVS outcome. However, we also followed up this case precisely using single photon emission computed tomography (SPECT) with easy Z-score imaging system (e-ZIS), and hypoperfusion at the locus of cSAH persisted for more than one year. This finding strongly suggests that tissue damage in the cSAH locus induced by RCVS may be subclinicaly irreversible, even though clinical symptoms and abnormalities in cranial MRI and MRA completely recover.SPECT may be a high sensitive technique to detect the irreversible lesion in RCVS.
一名59岁女性因霹雳样头痛就诊。头颅CT显示右侧顶叶皮质下蛛网膜下腔出血（cSAH），第5天行脑血管造影显示多处脑动脉狭窄，诊断为可逆性脑血管收缩综合征（RCVS）。第4天首次检查时磁共振血管造影（MRA）未检测到血管收缩，8天后 Willis 环周围出现血管收缩表现。头痛症状和血管收缩表现存在时间差异。临床症状完全恢复，两个月后头颅CT、磁共振成像/磁共振血管造影（MRI/MRA）结果可逆，提示RCVS预后较好。然而，我们还使用简易Z评分成像系统（e-ZIS）的单光子发射计算机断层扫描（SPECT）对该病例进行了精确随访，cSAH部位的灌注不足持续了一年多。这一发现强烈提示，尽管临床症状以及头颅MRI和MRA异常完全恢复，但RCVS所致cSAH部位的组织损伤可能在亚临床水平上是不可逆的。SPECT可能是检测RCVS不可逆病变的高敏感技术。
