Robert Th, Kawkabani Marchini A, Oumarou G, Uské A
Department of Clinical Neurosciences, Neurosurgery Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Clin Neurol Neurosurg. 2013 Nov;115(11):2351-7. doi: 10.1016/j.clineuro.2013.08.014. Epub 2013 Sep 7.
Reversible cerebral vasoconstriction syndrome (RCVS) is described as a clinical and radiological entity characterized by thunderclap headaches, a reversible segmental or multifocal vasoconstriction of cerebral arteries with or without focal neurological deficits or seizures. The purpose of this study is to determine risk factors of poor outcome in patients presented a RCVS.
A retrospective multi-center review of invasive and non-invasive neurovascular imaging between January 2006 and January 2011 has identified 10 patients with criterion of reversible segmental vasoconstriction syndrome. Demographics data, vascular risks and evolution of each of these patients were analyzed.
Seven of the ten patients were females with a mean age of 46 years. In four patients, we did not found any causative factors. Two cases presented RCVS in post-partum period between their first and their third week after delivery. The other three cases were drug-induced RCVS, mainly vaso-active drugs. Cannabis was found as the causative factor in two patient, Sumatriptan identified in one patient while cyclosporine was the causative agent in also one patient. The mean duration of clinical follow-up was 10.2 months (range: 0-28 months). Two patients had neurological sequelae: one patient kept a dysphasia and the other had a homonymous lateral hemianopia. We could not find any significant difference of the evolution between secondary RCVS and idiopathic RCVS. The only two factors, which could be correlated to the clinical outcome were the neurological status at admission and the presence of intraparenchymal abnormalities (ischemic stroke, hematoma) in brain imaging.
Fulminant vasoconstriction resulting in progressive symptoms or death has been reported in exceptional frequency. Physicians had to remember that such evolution could happen and predict them by identifying all factors of poor prognosis (neurological status at admission, the presence of intraparenchymal abnormalities).
可逆性脑血管收缩综合征（RCVS）被描述为一种临床和影像学实体，其特征为霹雳样头痛、脑动脉可逆性节段性或多灶性血管收缩，伴或不伴有局灶性神经功能缺损或癫痫发作。本研究的目的是确定出现RCVS患者预后不良的危险因素。
对2006年1月至2011年1月间侵袭性和非侵袭性神经血管成像进行回顾性多中心研究，确定了10例符合可逆性节段性血管收缩综合征标准的患者。分析了这些患者的人口统计学数据、血管危险因素及病情演变。
10例患者中有7例为女性，平均年龄46岁。4例患者未发现任何致病因素。2例患者在产后第一周和第三周之间出现RCVS。另外3例为药物性RCVS，主要是血管活性药物。2例患者的致病因素为大麻，1例患者为舒马曲坦，1例患者为环孢素。临床随访平均时间为10.2个月（范围：0 - 28个月）。2例患者有神经后遗症：1例患者留有失语症，另1例有同侧偏盲。继发性RCVS和特发性RCVS在病情演变方面未发现任何显著差异。唯一与临床结局相关的两个因素是入院时的神经状态以及脑成像中脑实质内异常（缺血性卒中、血肿）的存在。
已报道暴发性血管收缩导致进行性症状或死亡的情况极为罕见。医生必须记住这种情况可能发生，并通过识别所有预后不良因素（入院时的神经状态、脑实质内异常的存在）来进行预测。
