Jacoby Nuri, Kaunzner Ulrike, Dinkin Marc, Safdieh Joseph
New York Presbyterian Weill Cornell, New York, NY, USA.
Neurohospitalist. 2016 Jul;6(3):NP1-4. doi: 10.1177/1941874415599576. Epub 2015 Aug 13.
This is a case of a 52-year-old man with a past medical history of 2 episodes of coital thunderclap headaches as well as recent cocaine, marijuana, and pseudoephedrine use, who presented with sudden, sharp, posterior headache associated with photophobia and phonophobia. His initial magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography (MRA) of the head, and magnetic resonance venography (MRV) of the head were all normal as well as a normal lumbar puncture. Given the multiple risk factors for reversible cerebral vasoconstriction syndrome (RCVS), the patient was treated for suspected RCVS, despite the normal imaging. Repeat MRI brain 3 days after hospital admission demonstrated confluent white matter T2 hyperintensities most prominent in the occipital lobes, typical of posterior reversible encephalopathy syndrome (PRES). Repeat MRA of the head 1 day after discharge and 4 days after the abnormal MRI brain showed multisegment narrowing of multiple arteries. This case demonstrates that RCVS may present with PRES on MRI brain and also exemplifies the need to treat suspected RCVS even if imaging is normal, as abnormalities in both the MRI and the MRA may be delayed.
这是一名52岁男性患者，既往有2次性交性霹雳样头痛病史，近期使用过可卡因、大麻和伪麻黄碱，此次因突发、尖锐的后头痛伴畏光和畏声就诊。他最初的脑部磁共振成像（MRI）、头部磁共振血管造影（MRA）和头部磁共振静脉造影（MRV）均正常，腰椎穿刺也正常。鉴于存在可逆性脑血管收缩综合征（RCVS）的多种危险因素，尽管影像学检查正常，该患者仍接受了疑似RCVS的治疗。入院3天后复查脑部MRI显示枕叶最明显的融合性白质T2高信号，这是后部可逆性脑病综合征（PRES）的典型表现。出院1天后及脑部MRI异常4天后复查头部MRA显示多条动脉多节段狭窄。该病例表明，RCVS在脑部MRI上可能表现为PRES，也例证了即使影像学检查正常，对于疑似RCVS也需要进行治疗，因为MRI和MRA的异常可能会延迟出现。
