Chen Shih-Pin, Fuh Jong-Ling, Lirng Jiing-Feng, Wang Yen-Feng, Wang Shuu-Jiun
From the Faculty of Medicine (S.-P.C., J.-L.F., J.-F.L., Y.-F.W., S.-J.W.), National Yang-Ming University School of Medicine, Taipei; Department of Neurology, Neurological Institute (S.-P.C., J.-L.F., Y.-F.W., S.-J.W.), and Department of Radiology (J.-F.L.), Taipei Veterans General Hospital, Taipei; Brain Research Center (S.-P.C., J.-L.F., Y.-F.W., S.-J.W.), Institute of Clinical Medicine (Y.-F.W.), and Institute of Brain Science (S.-J.W.), National Yang-Ming University, Taipei, Taiwan.
Neurology. 2015 Apr 14;84(15):1552-8. doi: 10.1212/WNL.0000000000001473. Epub 2015 Mar 18.
We aimed to investigate whether reversible cerebral vasoconstriction syndrome (RCVS) could recur and to identify the potential predictors of recurrence in a large cohort of patients.
This study followed a cohort of 210 patients with RCVS in a hospital-based headache center from 2000 to 2012. All patients were regularly followed up by telephone after remission for RCVS and were particularly asked to return to our hospital immediately if they developed new acute, severe (i.e., thunderclap-like) headaches. Sequential neuroimaging studies were used to determine whether the patients had recurrent RCVS.
One hundred sixty-eight patients were successfully followed. The response rate was 80.8%, and the mean follow-up period was 37.5 ± 24.4 (range 6-131) months. Eighteen patients (10.7%) returned to our hospital because of new thunderclap-like headaches, and 9 (5.4% of the total 168, and 50% of 18) were confirmed to have recurrent RCVS that occurred a mean 40.9 ± 27.2 (median 35, range 6-87) months after the initial bout. The incidence rate was 1.71 per 100 person-years (95% confidence interval 1.68-1.75). Having sexual activities as a trigger for thunderclap headaches (hazard ratio = 5.68, 95% confidence interval 1.11-29.15, p = 0.038) was an independent predictor of recurrent RCVS. None of the patients with recurrent RCVS developed cerebrovascular complications.
Recurrent RCVS should be considered when patients with RCVS develop new thunderclap-like headaches. Having sexual activities as a trigger for RCVS is a potential predictor of recurrent RCVS.
我们旨在研究可逆性脑血管收缩综合征（RCVS）是否会复发，并确定一大群患者中复发的潜在预测因素。
本研究追踪了2000年至2012年在一家医院头痛中心的210例RCVS患者队列。所有患者在RCVS缓解后通过电话定期随访，特别要求如果出现新的急性、严重（即霹雳样）头痛，立即返回我院。采用序贯神经影像学研究来确定患者是否患有复发性RCVS。
168例患者成功随访。应答率为80.8%，平均随访期为37.5±24.4（范围6 - 131）个月。18例患者（10.7%）因新的霹雳样头痛返回我院，其中9例（占168例总数的5.4%，18例中的50%）被确诊为复发性RCVS，平均在初次发作后40.9±27.2（中位数35，范围6 - 87）个月发生。发病率为每100人年1.71例（95%置信区间1.68 - 1.75）。将性行为作为霹雳样头痛的诱因（风险比 = 5.68，95%置信区间1.11 - 29.15，p = 0.038）是复发性RCVS的独立预测因素。复发性RCVS患者均未发生脑血管并发症。
当RCVS患者出现新的霹雳样头痛时，应考虑复发性RCVS。将性行为作为RCVS的诱因是复发性RCVS的潜在预测因素。
