Tshibangu Mpuekela, McGuire Laura Stone, Theiss Peter, Alaraj Ali
Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA.
Interv Neuroradiol. 2024 May 15:15910199241251907. doi: 10.1177/15910199241251907.
Reversible cerebral vasoconstriction syndrome (RCVS) is an increasingly recognized condition characterized by thunderclap headache with or without other neurological deficits and diffuse vasoconstriction of cerebral arteries. Altered cerebrovascular tone may produce hemorrhage or stroke.
A retrospective review of patients with RCVS at our institution (2000-2023) yielded one case of pseudoaneurysm secondary to RCVS.
Diagnostic cerebral angiogram demonstrated diffuse multifocal segmental narrowing consistent with RCVS and a left M4 pseudoaneurysm in proximity to the cortical hemorrhage. The pseudoaneurysm was treated with branch vessel sacrifice using nBCA glue in a 1 : 3 ratio with ethiodized oil. After securing the source of hemorrhage, the patient received an intra-arterial infusion of Verapamil.
This unique presentation of pseudoaneurysm secondary to RCVS in this patient highlights the impact of hemodynamic alteration as a possible source of bleeding and demonstrates a potential management strategy. Endovascular management with nBCA glue embolization successfully treated this lesion.
可逆性脑血管收缩综合征（RCVS）是一种越来越被认可的疾病，其特征为霹雳样头痛，伴或不伴有其他神经功能缺损，以及脑动脉弥漫性血管收缩。脑血管张力改变可能导致出血或中风。
对我院（2000 - 2023年）的RCVS患者进行回顾性研究，发现1例继发于RCVS的假性动脉瘤病例。
诊断性脑血管造影显示弥漫性多灶性节段性狭窄，符合RCVS表现，且在皮质出血附近有1个左M4假性动脉瘤。使用nBCA胶与碘化油按1∶3比例栓塞分支血管治疗假性动脉瘤。在确定出血来源后，患者接受了维拉帕米动脉内输注。
该患者继发于RCVS的假性动脉瘤这一独特表现突出了血流动力学改变作为可能出血来源的影响，并展示了一种潜在的治疗策略。使用nBCA胶栓塞的血管内治疗成功治愈了该病变。
