Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Headache. 2014 Apr;54(4):736-44. doi: 10.1111/head.12319. Epub 2014 Mar 13.
To report 2 cases of reversible cerebral vasoconstriction syndrome (RCVS) with posterior reversible encephalopathy syndrome (PRES) after blood transfusion for severe anemia.
RCVS is presented with recurrent thunderclap headache and reversible constriction of cerebral arteries. PRES is a known complication of RCVS. Blood transfusion for severe anemia could be a cause for PRES in few cases; however, it is seldom mentioned as an etiology for RCVS.
We report a case series.
We report 2 women presented with RCVS with PRES after blood transfusion for anemia, and reviewed another 4 similar cases reported in the literature. Our 2 patients were middle-aged women, with severe chronic anemia (average hemoglobin: 1.45 g/dL), and received multiple blood transfusions (average: 3250 mL) over a period of 5-7 days. They developed thunderclap headache and other symptoms about 1 week after the last blood transfusion. Cerebral vasoconstrictions were demonstrated by magnetic resonance angiography and transcranial color-coded sonography. PRES was found in both of them using magnetic resonance imaging, and one of them also had cytotoxic edema on diffusion weighted image.
RCVS with PRES is one complication of blood transfusion in patients under chronic severe anemia (especially when hemoglobin level increased for more than 5 g/dL), particularly in Asian women with menorrhagia. Blood pressure surge and the occurrence of severe headaches or other neurological symptoms should be aggressively monitored within 10 days after the last blood transfusion.
报告 2 例因严重贫血输血后出现可逆性脑血管收缩综合征（RCVS）伴后部可逆性脑病综合征（PRES）的病例。
RCVS 表现为反复出现的霹雳性头痛和脑动脉可逆性收缩。PRES 是 RCVS 的已知并发症。在少数情况下，严重贫血输血可能是 PRES 的原因；然而，它很少被提及为 RCVS 的病因。
我们报告了一系列病例。
我们报告了 2 例因贫血输血后出现 RCVS 伴 PRES 的女性患者，并复习了文献中另外 4 例类似病例。我们的 2 例患者均为中年女性，患有严重慢性贫血（平均血红蛋白：1.45g/dL），并在 5-7 天内接受了多次输血（平均：3250mL）。她们在最后一次输血后约 1 周出现霹雳性头痛和其他症状。磁共振血管造影和经颅彩色超声显示脑血管收缩。她们均通过磁共振成像发现 PRES，其中 1 例还在弥散加权图像上出现细胞毒性水肿。
RCVS 伴 PRES 是慢性严重贫血患者（尤其是血红蛋白水平升高超过 5g/dL 的患者，尤其是月经过多的亚洲女性）输血的一种并发症。应在最后一次输血后 10 天内积极监测血压骤升和严重头痛或其他神经症状的发生。
