Wolff Valérie, Armspach Jean-Paul, Lauer Valérie, Rouyer Olivier, Ducros Anne, Marescaux Christian, Gény Bernard
Unité Neuro-Vasculaire, Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Cerebrovasc Dis. 2015;39(1):31-8. doi: 10.1159/000369776. Epub 2014 Dec 24.
Reversible vasoconstriction (RV) may cause ischaemic stroke (IS) in the absence of any other defined stroke aetiology. The three objectives of our study were to evaluate the frequency of RV in a prospective series of young IS patients, to describe the detailed clinical-radiological features in the patients with RV and IS, and to compare these characteristics with those of reversible cerebral vasoconstriction syndrome (RCVS).
We identified between October 2005 and December 2010, 159 consecutive young patients (<45 years) hospitalized for an acute IS confirmed by cerebral magnetic resonance imaging. An extensive diagnostic work-up was performed including toxicological urinary screening for cannabis, cocaine and amphetamines, and the usual biological, cardiac and vascular investigations for an IS in the young. We specifically studied patients with IS and RV, which was defined as multifocal intracranial arterial stenoses confirmed by intracranial arterial imaging that resolved within 3-6 months.
Out of 159 patients with IS, 21 (13%, 12 males, 9 females; mean age 32 years) had multifocal cerebral arterial stenoses that were fully reversible at 3-6 months, and no other cause for stroke. IS were located on posterior territory in 71% of cases, and vasoconstriction predominated on posterior cerebral and superior cerebellar arteries. Precipitating factors of IS and RV were the use of cannabis resin (n = 14), nasal decongestants (n = 2) and triptan (n = 1). Most cases (74%) had unusual severe headache, but none had thunderclap headache. None of 21 cases had reversible posterior leukoencephalopathy, cortical subarachnoid or intracerebral haemorrhage.
RV was the sole identified cause of IS in 13% of our cohort. These young patients with IS and RV may have a variant of RCVS, related to an increased susceptibility to vasoactive agents in some individuals. RV in our patients differs from the classical characteristics of RCVS by the absence of thunderclap headache, reversible brain oedema and subarachnoid or intracranial haemorrhage. Intracranial arteries should be looked for, by appropriate vascular imaging, in young patients with IS at the acute stage and during the follow-up period.
可逆性血管收缩（RV）在无其他明确的卒中病因时可导致缺血性卒中（IS）。我们研究的三个目的是评估前瞻性队列中年轻IS患者RV的发生率，描述RV合并IS患者详细的临床-影像学特征，并将这些特征与可逆性脑血管收缩综合征（RCVS）的特征进行比较。
我们确定了2005年10月至2010年12月期间因急性IS住院且经脑磁共振成像确诊的159例连续年轻患者（<45岁）。进行了广泛的诊断性检查，包括对大麻、可卡因和苯丙胺的毒理学尿液筛查，以及对年轻IS患者进行的常规生物学、心脏和血管检查。我们专门研究了IS合并RV的患者，RV定义为经颅内动脉成像证实的多灶性颅内动脉狭窄，且在3至6个月内缓解。
在159例IS患者中，21例（13%，男性12例，女性9例；平均年龄32岁）有多灶性脑动脉狭窄，在3至6个月时完全可逆，且无其他卒中病因。71%的病例中IS位于后循环区域，血管收缩主要累及大脑后动脉和小脑上动脉。IS和RV的诱发因素为使用大麻树脂（n = 14）、鼻减充血剂（n = 2）和曲坦类药物（n = 1）。大多数病例（74%）有异常严重的头痛，但无一例有霹雳样头痛。21例中无一例有可逆性后部白质脑病、皮质下蛛网膜下腔或脑内出血。
RV是我们队列中13%的IS患者唯一确定的病因。这些IS合并RV的年轻患者可能有一种RCVS的变体，与某些个体对血管活性药物的易感性增加有关。我们患者的RV与RCVS的经典特征不同，表现为无霹雳样头痛、可逆性脑水肿和蛛网膜下腔或颅内出血。对于急性期及随访期的年轻IS患者，应通过适当的血管成像检查颅内动脉。
