Asawavichienjinda Thanin, Jittapiromsak Nutchawan, Blumenfeld Andrew
Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, 1873 Rama IV Road, Pathum Wan District, Bangkok, 10330, Thailand.
Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Pain Ther. 2024 Dec;13(6):1705-1712. doi: 10.1007/s40122-024-00665-8. Epub 2024 Oct 4.
Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies that target CGRP ligands or receptors, may cause a very rare side effect of reversible cerebral vasoconstriction syndrome (RCVS). This study is a case report of a patient who developed cerebral artery vasoconstriction documented on serial brain magnetic resonance angiography (MRA) scans without the typical manifestations of RCVS following galcanezumab loading dose. Case report: A 40-year-old female patient with high-frequency episodic migraine with visual aura on topiramate 100 mg/day developed transient numbness of the right upper and lower extremities and right face without headache and a normal neurological examination 10 min after a loading dose of galcanezumab, which resolved over the next 2 days. Magnetic resonance angiography brain imaging showed segmental arterial constriction of both middle cerebral arteries in the M1-2 segments and both posterior cerebral arteries in the P1-2 segments, which partial resolved in a subsequent study by the end of 6 months. There were no other supporting examination data, such as transcranial Doppler, which might provide additional information on the progression and improvement of the vasoconstriction. Her differential diagnosis included prolonged migraine sensory aura without headache, RCVS, or cerebral vasoconstriction secondary to the effect of an anti-CGRP monoclonal antibody. Further research needs to be conducted.
靶向降钙素基因相关肽（CGRP）配体或受体的抗CGRP单克隆抗体可能会引起一种非常罕见的可逆性脑血管收缩综合征（RCVS）副作用。本研究是一例患者的病例报告，该患者在接受加卡尼单抗负荷剂量后，连续脑部磁共振血管造影（MRA）扫描记录到脑动脉血管收缩，但无RCVS的典型表现。病例报告：一名40岁女性患者，每日服用100毫克托吡酯治疗伴有视觉先兆的高频发作性偏头痛，在接受加卡尼单抗负荷剂量10分钟后，出现右上肢、下肢和右面部短暂麻木，无头痛，神经系统检查正常，在接下来的2天内症状缓解。脑部磁共振血管造影成像显示，大脑中动脉M1-2段和大脑后动脉P1-2段均出现节段性动脉收缩，在6个月末的后续研究中部分缓解。没有其他支持性检查数据，如经颅多普勒检查，其可能提供有关血管收缩进展和改善的更多信息。她的鉴别诊断包括无头痛的延长型偏头痛感觉先兆、RCVS或抗CGRP单克隆抗体作用继发的脑血管收缩。需要进行进一步的研究。
