From the Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.C., M.J.L., C.-S.C.).
Neuroscience Center, Samsung Medical Center, Seoul, South Korea (S.C., M.J.L., C.-S.C.).
Stroke. 2020 May;51(5):1451-1457. doi: 10.1161/STROKEAHA.119.028656. Epub 2020 Apr 17.
Background and Purpose- Reversible cerebral vasoconstriction syndrome (RCVS) has a unique temporal course of vasoconstriction. Blood-brain barrier (BBB) breakdown is part of the pathophysiology of RCVS, but its temporal course is unknown. We aimed to investigate the temporal profile of BBB breakdown and relevant clinical profiles in a large sample size. Methods- In this prospective observatory bicenter study, patients who underwent contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging within 2 months from onset were included. The presence and extent of BBB breakdown were evaluated using contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging. Contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging data were analyzed using a semiautomated segmentation technique to quantitatively measure the area of Gadolinium leakage into cerebrospinal fluid space. The univariable and multivariable linear regressions were performed to investigate the independent effect of time from onset with adjustment for other covariates. Results- In the 186 patients with angiogram-proven RCVS included in this analysis, BBB breakdown was observed in 52.6%, 56.8%, 30.3%, 40.0%, and 23.8% in the first, second, third, fourth, and ≥fifth week after onset. The extent of BBB breakdown peaked at first and second week, whereas the peak of vasoconstriction was observed at the third week after onset. Multivariable analysis showed the second week from onset (β, 3.35 [95% CI, 0.07-6.64]; =0.046) and blood pressure surge (β, 3.84 [95% CI, 1.75-5.92]; <0.001) were independently associated with a greater extent of BBB breakdown. A synergistic effect of time from onset and blood pressure surge was found ( for interaction=0.006). Conclusions- Frequency and extent of BBB breakdown are more prominent during the early stage in patients with RCVS, with an earlier peak than that of vasoconstriction. The temporal course of BBB breakdown may provide a pathophysiologic background of the temporal course of neurological complications of RCVS.
背景与目的-可逆性脑血管收缩综合征（RCVS）具有独特的血管收缩时间过程。血脑屏障（BBB）破坏是 RCVS 病理生理学的一部分，但它的时间过程尚不清楚。我们的目的是在大样本量中研究 BBB 破坏的时间特征和相关的临床特征。
方法-在这项前瞻性观察性双中心研究中，纳入了发病后 2 个月内接受对比增强液体衰减反转恢复磁共振成像（CE-FLAIR MRI）的患者。使用 CE-FLAIR MRI 评估 BBB 破坏的存在和程度。使用半自动分割技术分析 CE-FLAIR MRI 数据，定量测量钆漏入脑脊液空间的面积。进行单变量和多变量线性回归，以调查发病后时间的独立影响，并进行其他协变量的调整。
结果-在这项分析中，纳入了 186 例经血管造影证实的 RCVS 患者，在发病后第 1、2、3、4 和≥第 5 周，分别有 52.6%、56.8%、30.3%、40.0%和 23.8%的患者出现 BBB 破坏。BBB 破坏的程度在第 1 和第 2 周达到高峰，而血管收缩的高峰出现在发病后第 3 周。多变量分析显示，发病后第 2 周（β，3.35[95%置信区间，0.07-6.64]；=0.046）和血压骤升（β，3.84[95%置信区间，1.75-5.92]；<0.001）与 BBB 破坏程度更大独立相关。发现发病时间和血压骤升之间存在协同作用（ for 交互=0.006）。
结论-在 RCVS 患者中，BBB 破坏的频率和程度在早期更为突出，早于血管收缩的高峰。BBB 破坏的时间过程可能为 RCVS 神经并发症的时间过程提供病理生理学背景。
