Ducros Anne, Wolff Valérie
Department of Neurology, Montpellier University Hospital, and Montpellier University, Montpellier, France (A. Ducros).
Stroke Unit, Department of Neurology, Strasbourg University Hospital, Strasbourg, France (V. Wolff).
Headache. 2016 Apr;56(4):657-73. doi: 10.1111/head.12797. Epub 2016 Mar 26.
During the last 10 years, reversible cerebral vasoconstriction syndrome (RCVS) has emerged as the most frequent cause of thunderclap headache (TCH) in patients without aneurysmal subarachnoid hemorrhage, and as the most frequent cause of recurrent TCHs. The typical TCHs of RCVS are multiple, recurring over a few days to weeks, excruciating, short-lived, and brought up by exertion, sexual activities, emotion, Valsalva maneuvers, or bathing, among other triggers. All these triggers induce sympathetic activation. In a minority of cases with RCVS, TCH heralds stroke and rarely death. Early diagnosis of RCVS in patients who present with isolated headache enables proper management and might reduce the risk of eventual stroke. This review describes the characteristics, triggers, diagnosis, and management of TCH in RCVS. One aim is to underline that the TCH pattern of RCVS is so typical that it enables, according to the 2013 revision of the International Classification of Headache Disorders, the diagnosis of "probable RCVS" in patients with such a headache pattern, normal cerebral angiography, and no other cause. Another objective is to discuss the role of physical and emotional stress in RCVS and in other related conditions involving similar triggers.
在过去10年中，可逆性脑血管收缩综合征（RCVS）已成为非动脉瘤性蛛网膜下腔出血患者中霹雳样头痛（TCH）最常见的病因，也是复发性TCH最常见的病因。RCVS典型的TCH为多发性，在数天至数周内反复出现，疼痛剧烈，持续时间短，可由运动、性活动、情绪、瓦尔萨尔瓦动作或洗澡等多种诱因诱发。所有这些诱因均可引起交感神经激活。在少数RCVS病例中，TCH预示着中风，很少导致死亡。对以孤立性头痛就诊的患者进行RCVS早期诊断，有助于进行恰当的治疗，并可能降低最终发生中风的风险。本综述描述了RCVS中TCH的特点、诱因、诊断及治疗。一个目的是强调，根据《国际头痛疾病分类》2013年修订版，RCVS的TCH模式非常典型，对于具有这种头痛模式、脑血管造影正常且无其他病因的患者，可诊断为“可能的RCVS”。另一个目的是讨论身体和情绪应激在RCVS以及其他涉及类似诱因的相关疾病中的作用。
