Department of Neurology, TOYOTA Memorial Hospital, Toyota, Aichi, Japan; Department of Molecular Therapy, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan; Department of NCNP Brain Physiology and Pathology, Graduate school of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo, Tokyo, Japan.
Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
J Neurol Sci. 2022 Nov 15;442:120441. doi: 10.1016/j.jns.2022.120441. Epub 2022 Sep 29.
Blood-brain barrier (BBB) breakdown is considered a key step in the pathophysiology of reversible cerebral vasoconstriction syndrome (RCVS); however, its temporal course remains unclear. Based on the characteristics and dynamics of Tc-ethyl cysteinate dimer (Tc-ECD) as a tracer, Tc-ECD single-photon emission computed tomography (SPECT) can detect not only hypoperfusion but also BBB breakdown and/or brain tissue damage. Therefore, this study aimed to investigate this course using Tc-ECD SPECT.
Between 2011 and 2019, we enrolled seven patients (one male and six female patients) with RCVS without ischemic or hemorrhagic stroke or posterior reversible encephalopathy syndrome. Tc-ECD SPECT was performed repeatedly in each patient. SPECT data were statistically analyzed using an easy Z-score imaging system.
Thunderclap headache was the initial symptom in all the patients and was most commonly triggered by bathing (three patients). All the patients exhibited vasoconstriction and reduced cerebral uptake of Tc-ECD during the acute stage. Follow-up assessment from 3 to 16 months showed that reduced cerebral uptake persisted in all the patients, even after the vasoconstriction had resolved.
Reduced cerebral uptake of Tc-ECD persisted in the late stage of RCVS, even after vasoconstriction and headache subsided. BBB breakdown and/or brain tissue damage may underlie this phenomenon. Tc-ECD SPECT is an effective neuroimaging method to detect brain functional abnormalities, reflecting BBB breakdown or tissue damages, throughout the treatment course of RCVS.
血脑屏障（BBB）破坏被认为是可逆性脑血管收缩综合征（RCVS）病理生理学中的关键步骤；然而，其时间过程尚不清楚。基于 Tc-乙基半胱氨酸二聚体（Tc-ECD）作为示踪剂的特征和动力学，Tc-ECD 单光子发射计算机断层扫描（SPECT）不仅可以检测到灌注不足，还可以检测到 BBB 破坏和/或脑组织损伤。因此，本研究旨在使用 Tc-ECD SPECT 来研究这一过程。
在 2011 年至 2019 年期间，我们纳入了 7 例 RCVS 患者（1 例男性，6 例女性），这些患者没有缺血性或出血性中风或后部可逆性脑病综合征。对每位患者均重复进行 Tc-ECD SPECT 检查。使用 easy Z-score 成像系统对 SPECT 数据进行统计分析。
所有患者均以霹雳性头痛为首发症状，最常见的诱因是洗澡（3 例）。所有患者在急性期均表现为血管收缩和 Tc-ECD 脑摄取减少。3 至 16 个月的随访评估显示，即使血管收缩已经缓解，所有患者的脑摄取仍持续减少。
即使血管收缩和头痛缓解后，RCVS 的晚期仍存在 Tc-ECD 脑摄取减少。这可能是 BBB 破坏和/或脑组织损伤所致。Tc-ECD SPECT 是一种有效的神经影像学方法，可在 RCVS 的整个治疗过程中检测到脑功能异常，反映 BBB 破坏或组织损伤。
