Shimoda M, Oda S, Hirayama A, Imai M, Komatsu F, Hoshikawa K, Shigematsu H, Nishiyama J, Osada T
From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan
From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan.
AJNR Am J Neuroradiol. 2016 Sep;37(9):1594-8. doi: 10.3174/ajnr.A4768. Epub 2016 Apr 14.
Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache and diffuse segmental vasoconstriction that resolves spontaneously within 3 months. Previous reports have proposed that vasoconstriction first involves small distal arteries and then progresses toward major vessels at the time of thunderclap headache remission. The purpose of this study was to confirm centripetal propagation of vasoconstriction on MRA at the time of thunderclap headache remission compared with MRA at the time of reversible cerebral vasoconstriction syndrome onset.
Of the 39 patients diagnosed with reversible cerebral vasoconstriction syndrome at our hospital during the study period, participants comprised the 16 patients who underwent MR imaging, including MRA, within 72 hours of reversible cerebral vasoconstriction syndrome onset (initial MRA) and within 48 hours of thunderclap headache remission.
In 14 of the 16 patients (87.5%), centripetal propagation of vasoconstriction occurred from the initial MRA to remission of thunderclap headache, with typical segmental vasoconstriction of major vessels. These mainly involved the M1 portion of the MCA (10 cases), P1 portion of the posterior cerebral artery (10 cases), and A1 portion of the anterior cerebral artery (5 cases).
This study found evidence of centripetal propagation of vasoconstriction on MRA obtained at the time of thunderclap headache remission, compared with MRA obtained at the time of reversible cerebral vasoconstriction syndrome onset. If clinicians remain unsure of the diagnosis during early-stage reversible cerebral vasoconstriction syndrome, this time point represents the best opportunity to diagnose reversible cerebral vasoconstriction syndrome with confidence.
可逆性脑血管收缩综合征的特点是霹雳样头痛和弥漫性节段性血管收缩，在3个月内可自发缓解。既往报道提出，血管收缩首先累及远端小动脉，然后在霹雳样头痛缓解时向主要血管发展。本研究的目的是与可逆性脑血管收缩综合征发病时的磁共振血管造影（MRA）相比，证实霹雳样头痛缓解时MRA上血管收缩的向心性扩展。
在研究期间，我院诊断为可逆性脑血管收缩综合征的39例患者中，参与者包括16例在可逆性脑血管收缩综合征发病72小时内（初始MRA）和霹雳样头痛缓解48小时内接受包括MRA在内的磁共振成像检查的患者。
16例患者中有14例（87.5%）出现从初始MRA到霹雳样头痛缓解的血管收缩向心性扩展，主要血管有典型的节段性血管收缩。这些主要累及大脑中动脉M1段（10例）、大脑后动脉P1段（10例）和大脑前动脉A1段（5例）。
本研究发现，与可逆性脑血管收缩综合征发病时获得的MRA相比，霹雳样头痛缓解时获得的MRA上有血管收缩向心性扩展的证据。如果临床医生在可逆性脑血管收缩综合征早期仍不能确定诊断，这个时间点是确诊可逆性脑血管收缩综合征的最佳时机。
