1 Department of Neurology, University of Lübeck, Lübeck, Germany.
2 Department of Neuroradiology, University of Lübeck, Lübeck, Germany.
Cephalalgia. 2018 Apr;38(5):984-987. doi: 10.1177/0333102417714245. Epub 2017 Jun 13.
Background Reversible cerebral vasoconstriction syndrome (RCVS) is an important differential diagnosis of singular or recurrent thunderclap headache. Prognosis is generally good, however complications of the transient segmental vasospasms of cerebral arteries such as stroke, subarachnoidal hemorrhage and brain edema may worsen the clinical outcome. Although the exact pathomechanism is still unclear, various vasoactive substances and conditions (e.g. post partum) have been identified as triggering RCVS. Cases We report on the clinical course and management of two cases of typical RCVS that were associated with two different precipitants previously not described: A gastrointestinal infection and isoflavones, which are phytoestrogens used for menopausal vasomotor symptoms. Discussion In the case of gastrointestinal infection, either systemic inflammatory processes might lead to disturbances of vascular tone, or the repetitive vomiting that resembles Valsalva manoeuvers known to trigger RCVS. In the case of isoflavone intake, it may be their estrogenic potential that induces dysregulation of cerebral arteries, a mechanism known from other states of hormonal change such as post-partum angiopathy. However, the association of both precipitating factors with RCVS in our two cases is not a proof for a causal relationship, and there may have been additional potential triggers for RCVS. Conclusion In patients with (gastrointestinal) infection and concomitant thunderclap headache, RCVS should be considered as an important differential diagnosis due to its major complications. Since RCVS may be triggered by various vasoactive substances, taking the medical history should always include over-the-counter drugs and dietary supplements (such as the isoflavones) beside the regular medication.
可逆性脑血管收缩综合征（RCVS）是单发或复发性霹雳性头痛的重要鉴别诊断。一般预后良好，但脑动脉短暂节段性血管痉挛的并发症，如中风、蛛网膜下腔出血和脑水肿，可能使临床预后恶化。尽管确切的发病机制尚不清楚，但各种血管活性物质和情况（如产后）已被确定为触发 RCVS 的原因。
我们报告了两例典型 RCVS 的临床经过和治疗，这两例与以前未描述的两个不同诱因有关：胃肠道感染和异黄酮，异黄酮是用于治疗绝经血管舒缩症状的植物雌激素。
在胃肠道感染的情况下，全身性炎症过程可能导致血管张力紊乱，或者类似于已知可引发 RCVS 的瓦尔萨尔瓦动作的反复呕吐。在异黄酮摄入的情况下，可能是其雌激素潜力导致大脑动脉失调，这种机制在其他激素变化状态（如产后血管病）中已经知晓。然而，我们两例病例中这两种诱发因素与 RCVS 的关联并不能证明因果关系，可能还有其他潜在的 RCVS 诱因。
在（胃肠道）感染和伴随霹雳性头痛的患者中，由于其主要并发症，RCVS 应被视为重要的鉴别诊断。由于 RCVS 可能由各种血管活性物质引发，因此在询问病史时，除了常规用药外，还应包括非处方药物和膳食补充剂（如异黄酮）。
