Department of Neurology, Hospital da Luz, Lisbon, Portugal; Headache Center, Hospital da Luz, Lisbon, Portugal.
Department of Neurology, Hospital da Luz, Lisbon, Portugal.
Rev Neurol (Paris). 2022 Apr;178(4):385-390. doi: 10.1016/j.neurol.2021.06.015. Epub 2021 Oct 21.
To describe transcranial Doppler (TCD) findings in a population with clinical probable RCVS. Exploratory objectives included the study of clinical characteristics of probable RCVS patients with and without spasm detected by TCD.
Cross-sectional cohort study of patients with thunderclap headache (TCH) without subarachnoid hemorrhage (SAH) of our neurology and headache center between 2010 and 2019, selecting patients with clinical diagnosis of probable RCVS (negative angiography study) by ICHD-3 criteria and with at least two TCD studies.
From 114 TCH patients, 36/114 had probable RCVS by ICHD-3 criteria and had at least two TCD studies available. The mean age at RCVS onset was 42.9years (21-72years); 29/36 (80.6%) were female, 7/28 (25%) had cardiovascular risk factors and 20/36 (55.6%) had history of migraine. Most common triggers were stressful emotion, drugs, valsalva maneuvers and sexual activity. Five/36 (13.9%) had complications and 3/36 (8.3%) had late recurrence. Initial TCD was performed on average of 16 (6-26) days after headache onset. Twenty-nine had vasospasm on TCD, presenting mean flow velocity of MCA (VMCA) of 135.7±17.0cm/s and mean maximum VMCA of 138.3±17.2. Vasospasm was mild in 21/29 patients (72.4%) and moderate in 8/29 (27.6%). Complete VMCA normalization occurred on average 41 (30-70) days after headache onset and 24 (11-47) days after initial TCD. The group of patients with vasospasm detected by TCD had more female patients (26/29, 89.7% vs. 3/7, 42.8%, P=0.016), and more TCH attacks (mean of 3.6 vs. 2.14, P=0.049).
TCD may be a useful tool in the identification of vasospasm in patients with probable RCVS, supporting the diagnosis of RCVS in patients presenting with recurrent TCH without SAH.
描述临床疑似 RCVS 患者的经颅多普勒 (TCD) 检查结果。探索性目标包括研究 TCD 检测到痉挛和未检测到痉挛的疑似 RCVS 患者的临床特征。
对 2010 年至 2019 年间在我们的神经病学和头痛中心因突发头痛 (TCH) 就诊且未发生蛛网膜下腔出血 (SAH) 的患者进行了横断面队列研究，选择符合 ICHD-3 标准的临床诊断为疑似 RCVS（阴性血管造影研究）且至少有 2 次 TCD 检查的患者。
114 例 TCH 患者中，36/114 例根据 ICHD-3 标准诊断为疑似 RCVS，并至少有 2 次 TCD 检查结果。RCVS 发病年龄平均为 42.9 岁（21-72 岁）；29/36（80.6%）为女性，7/28（25%）有心血管危险因素，20/36（55.6%）有偏头痛病史。最常见的诱因是情绪压力、药物、瓦氏动作和性行为。5/36（13.9%）有并发症，3/36（8.3%）有迟发性复发。初始 TCD 平均在头痛发作后 16（6-26）天进行。29 例 TCD 显示有血管痉挛，MCA（VMCA）平均血流速度为 135.7±17.0cm/s，最大 VMCA 平均为 138.3±17.2cm/s。21/29（72.4%）例患者的血管痉挛为轻度，8/29（27.6%）例为中度。头痛发作后平均 41（30-70）天 VMCA 完全正常，头痛发作后初始 TCD 后 24（11-47）天 VMCA 完全正常。在 TCD 检测到血管痉挛的患者中，女性患者更多（26/29，89.7% vs. 3/7，42.8%，P=0.016），TCH 发作次数也更多（平均 3.6 次 vs. 2.14 次，P=0.049）。
TCD 可能是识别疑似 RCVS 患者血管痉挛的有用工具，支持对无蛛网膜下腔出血的复发性 TCH 患者的 RCVS 诊断。
