Manuel Ana Rute, Gonçalves Carolina, Silva Adriana, Escobar Carlos, Manaças Rui, Luís Catarina
Child and Youth Department (A.R.M., C.G., A.S., C.L.), Hospital Professor Doutor Fernando Fonseca; Pediatric Intensive Care Unit (C.E.), Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal; and Neuroradiology Unit (R.M.), Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
Neurol Clin Pract. 2022 Oct;12(5):e116-e120. doi: 10.1212/CPJ.0000000000200069.
We describe the case of a healthy boy diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES).
He was identified after presenting in the emergency department (ED). A review of the 5 previous cases of RCVS complicated with PRES reported in the literature was performed.
A 9-year-old boy was brought to the ED for intense, throbbing headache and vomiting. Physical and neurologic examinations were normal. Brain CT and CSF examination were unremarkable, and he was discharged after symptomatic relief. Five days later, he returned to the ED for generalized tonic-clonic seizures that ceased with levetiracetam. MRI with angiography showed PRES. Systolic hypertension refractory to therapy was documented. New-onset fluctuating right-sided paresis and paresthesia appeared, so MRI was repeated, showing diffuse cerebral vasoconstriction suggesting RCVS. Nimodipine was started with complete resolution of symptoms and normalization of blood pressure. Four weeks after discharge, TD and MRI showed total vasospasm resolution. There was no recurrence in 12-month follow-up.
This case emphasizes the interconnection between RCVS and PRES, highlighting the need to include both as differential diagnoses for severe headache and the essential role of MR angiography in the investigation.
我们描述了一例被诊断为可逆性脑血管收缩综合征（RCVS）和后部可逆性脑病综合征（PRES）的健康男孩的病例。
他在急诊科就诊后被确诊。我们对文献中报道的5例先前合并PRES的RCVS病例进行了回顾。
一名9岁男孩因剧烈搏动性头痛和呕吐被送往急诊科。体格检查和神经系统检查均正常。脑部CT和脑脊液检查无异常，症状缓解后出院。五天后，他因全身性强直阵挛发作再次回到急诊科，使用左乙拉西坦后发作停止。磁共振血管造影成像显示为PRES。记录到对治疗难治的收缩期高血压。出现了新发的波动性右侧轻瘫和感觉异常，因此再次进行磁共振成像，显示弥漫性脑血管收缩，提示为RCVS。开始使用尼莫地平后症状完全缓解，血压恢复正常。出院四周后，经颅多普勒（TD）和磁共振成像显示血管痉挛完全消退。在12个月的随访中无复发。
该病例强调了RCVS和PRES之间的相互联系，突出了将两者都纳入严重头痛鉴别诊断的必要性以及磁共振血管造影在检查中的重要作用。
