Yamamoto Akitaka, Omori Yukinari, Shindo Akihiro, Imai Hiroshi, Suzuki Hidenori
Emergency and Critical Care Center Mie General Medical Center Yokkaichi Mie Japan.
Department of Neurosurgery Mie University Graduate School of Medicine Tsu Mie Japan.
Acute Med Surg. 2017 Jul 28;4(4):458-461. doi: 10.1002/ams2.300. eCollection 2017 Oct.
Reversible cerebral vasoconstriction syndrome (RCVS) is an increasingly recognized and important cause of thunderclap headache. Delays in diagnosis may cause deterioration of symptoms and concomitant unnecessary investigations. However, the diagnosis of RCVS in the acute stage remains difficult.A 41-year-old man was admitted to the emergency department for severe, recurrent occipital headaches. The results of initial computed tomography and magnetic resonance imaging (MRI) of the brain and cerebrospinal fluid analysis were normal. Magnetic resonance angiography (MRA) showed multisegmental luminal stenosis of the basilar artery. Basi-parallel anatomical scanning (BPAS)-MRI, illustrating the outer contour of the vertebrobasilar artery, also showed multisegmental stenosis.
The patient was speculated as having RCVS and was treated with oral lomerizine hydrochloride. Repeat MRA and BPAS-MRI 2 months later showed resolution, confirming RCVS.
Combined with MRA, BPAS-MRI is an effective and non-invasive imaging method for diagnosis of RCVS of the basilar artery.
可逆性脑血管收缩综合征（RCVS）是霹雳样头痛越来越被认识到的重要病因。诊断延迟可能导致症状恶化并伴随不必要的检查。然而，RCVS在急性期的诊断仍然困难。一名41岁男性因严重反复枕部头痛入住急诊科。最初的脑部计算机断层扫描、磁共振成像（MRI）及脑脊液分析结果均正常。磁共振血管造影（MRA）显示基底动脉多节段管腔狭窄。基底平行解剖扫描（BPAS）-MRI显示椎基底动脉外轮廓，也显示多节段狭窄。
推测该患者患有RCVS，给予口服盐酸洛美利嗪治疗。2个月后重复MRA和BPAS-MRI显示病变消退，确诊为RCVS。
BPAS-MRI联合MRA是诊断基底动脉RCVS的一种有效且无创的成像方法。
