Choi Kyu-Sun, Yi Hyeong-Joong
Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
J Korean Neurosurg Soc. 2014 Nov;56(5):419-22. doi: 10.3340/jkns.2014.56.5.419. Epub 2014 Nov 30.
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset headache with focal neurologic deficit and prolonged but reversible multifocal narrowing of the distal cerebral arteries. Stroke, either hemorrhagic or ischemic, is a relatively frequent presentation in RCVS, but progressive manifestations of subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction in a patient is seldom described. We report a rare case of a 56-year-old woman with reversible cerebral vasoconstriction syndrome consecutively presenting as cortical subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction. When she complained of severe headache with subtle cortical subarachnoid hemorrhage, her angiography was non-specific. But, computed tomographic angiography showed typical angiographic features of this syndrome after four days. Day 12, she suffered mental deterioration and hemiplegia due to contralateral intracerebral hematoma, and she was surgically treated. For recurrent attacks of headache, medical management with calcium channel blockers has been instituted. Normalized angiographic features were documented after 8 weeks. Reversible cerebral vasoconstriction syndrome should be considered as differential diagnosis of non-aneurysmal subarachnoid hemorrhage, and repeated angiography is recommended for the diagnosis of this under-recognized syndrome.
可逆性脑血管收缩综合征（RCVS）的特点是突发头痛伴局灶性神经功能缺损，以及远端脑动脉出现持续但可逆的多灶性狭窄。出血性或缺血性卒中是RCVS中相对常见的表现，但很少有患者出现蛛网膜下腔出血、脑出血、脑梗死的进行性表现的报道。我们报告了一例罕见的56岁女性病例，其可逆性脑血管收缩综合征先后表现为皮质蛛网膜下腔出血、脑出血和脑梗死。当她主诉严重头痛伴轻微皮质蛛网膜下腔出血时，其血管造影无特异性表现。但4天后，计算机断层血管造影显示了该综合征典型的血管造影特征。第12天，她因对侧脑内血肿出现精神恶化和偏瘫，并接受了手术治疗。针对反复出现的头痛发作，已采用钙通道阻滞剂进行药物治疗。8周后记录到血管造影特征恢复正常。可逆性脑血管收缩综合征应被视为非动脉瘤性蛛网膜下腔出血的鉴别诊断，对于这种认识不足的综合征，建议进行重复血管造影以明确诊断。
