McIlroy Ed, Sethuraman Rajamani, Woograsingh Reshma, Nelson-Piercy Catherine, Gilbert-Kawai Edward
From the *Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom; †Women's Health Academic Centre, King's Health Partners Directorate Office, London, United Kingdom; and ‡North Wing, St Thomas' Hospital, London, United Kingdom.
A A Case Rep. 2017 Nov 15;9(10):289-291. doi: 10.1213/XAA.0000000000000595.
Reversible cerebrovascular vasoconstriction syndrome is an uncommon condition that presents as severe headache and hypertension. Recent literature suggests a 1% incidence in postpartum headache cases. It can cause subarachnoid hemorrhages, cerebral ischemia, and seizures. It is often misdiagnosed as postdural puncture headache or preeclampsia. In this case, a postpartum woman, who had received epidural anesthesia for labor, presented 5 days postpartum with severe headache that did not resolve with an epidural blood patch. She then became more hypertensive and suffered a grand mal seizure. When treatment for eclampsia failed to resolve her symptoms, magnetic resonance angiography was performed. It demonstrated the pathognomic signs of reversible cerebrovascular vasoconstriction syndrome. Her symptoms resolved with nimodipine.
可逆性脑血管收缩综合征是一种罕见疾病，表现为严重头痛和高血压。近期文献表明，产后头痛病例中的发病率为1%。它可导致蛛网膜下腔出血、脑缺血和癫痫发作。它常被误诊为硬膜穿刺后头痛或先兆子痫。在本病例中，一名分娩时接受硬膜外麻醉的产后女性，产后5天出现严重头痛，硬膜外血贴治疗无效。随后她血压升高并发生大发作癫痫。子痫治疗未能缓解其症状，遂行磁共振血管造影。结果显示出可逆性脑血管收缩综合征的特征性征象。使用尼莫地平后她的症状得到缓解。
