Takemaru Makoto, Takeshima Shinichi, Hara Naoyuki, Himeno Takahiro, Shiga Yuji, Takeshita Jun, Takamatsu Kazuhiro, Nomura Eiichi, Shimoe Yutaka, Kuriyama Masaru
Brain Attack Center, Ota Memorial Hospital, Department of Neurology.
Present address: Showa University School of Medicine.
Rinsho Shinkeigaku. 2018 Jun 27;58(6):377-384. doi: 10.5692/clinicalneurol.cn-001143. Epub 2018 Jun 1.
This study reports eleven cases of reversible cerebral vasospasm syndrome (RCVS). Of the 11 patients, two were males and nine were females, with the average age of 47.9 ± 14.1 years. Many of these patients were young. The rates of severe, intractable and pulsative headache, generalized convulsions, and motor hemiparesis were 64%, 27%, and 36%, respectively. As complications of intracerebral lesions in the early stage of disease onset, convexal subarachnoid hemorrhage, lobar intracerebral hemorrhage, and posterior reversible encephalopathy syndrome were observed in 63%, 9%, and 45% of cases, respectively. Cerebral infarction occurred in 45% of cases at around 1-3 weeks after onset. Improvement of cerebral vasoconstriction was recognized in several cases from about the first month of onset. The post-partum period, migraine, transfusion, rapid amelioration for anemia, renal failure, bathing, and cerebrovascular dissection were suspected as disease triggers. Abnormally high blood pressure at onset was confirmed in 55% of cases. It is important to analyze the pathophysiology of RCVS associated with these triggers from the viewpoint of the breakdown of the blood-brain barrier.
本研究报告了11例可逆性脑血管痉挛综合征(RCVS)。11例患者中,男性2例,女性9例,平均年龄47.9±14.1岁。这些患者中许多较为年轻。严重、顽固性搏动性头痛、全身性惊厥和运动性偏瘫的发生率分别为64%、27%和36%。作为疾病发作早期脑内病变的并发症,分别有63%、9%和45%的病例观察到脑凸面蛛网膜下腔出血、脑叶脑出血和后部可逆性脑病综合征。45%的病例在发病后1至3周左右发生脑梗死。从发病后约第一个月起,在几例患者中发现脑血管收缩有所改善。产后时期、偏头痛、输血、贫血快速改善、肾衰竭、沐浴和脑血管夹层被怀疑为疾病触发因素。55%的病例在发病时证实有血压异常升高。从血脑屏障破坏的角度分析与这些触发因素相关的RCVS的病理生理学很重要。