Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Chiba, Japan.
J Med Invest. 2024;71(3.4):323-326. doi: 10.2152/jmi.71.323.
A 49-year-old woman with a family history of Moyamoya disease presented with sudden onset of right hemiparesis without headache. Magnetic resonance imaging (MRI) of the head revealed a cerebral infarct in the left corona radiata, and magnetic resonance angiography (MRA) revealed severe stenosis of the bilateral internal carotid, middle, anterior, and posterior cerebral arteries. Antithrombotic therapy improved her symptoms. After 2 weeks, MRA revealed changes in cerebral arterial vasodilation, indicating reversible cerebral vasoconstriction syndrome (RCVS). Five months later, she presented with transient dysarthria without headache ; MRA revealed multiple cerebral artery stenosis, and 2 days later, it revealed changes in cerebral arterial vasodilation. RCVS presents with reversible multifocal narrowing of the cerebral arteries with thunderclap headache, commonly observed in middle-aged women. RCVS without headache is rare. RCVS should be a differential diagnosis in patients with multiple cerebral artery stenoses without headache, and serial MRI is important for its diagnosis. J. Med. Invest. 71 : 323-326, August, 2024.
一位 49 岁的女性，有 Moyamoya 病家族史，突发右侧偏瘫，无头痛。头部磁共振成像（MRI）显示左侧冠状辐射区脑梗死，磁共振血管造影（MRA）显示双侧颈内、中、前、后动脉严重狭窄。抗血栓治疗改善了她的症状。2 周后，MRA 显示脑动脉扩张性改变，提示可逆性脑血管收缩综合征（RCVS）。5 个月后，她出现短暂性构音障碍，无头痛；MRA 显示多发性脑动脉狭窄，2 天后显示脑动脉扩张性改变。RCVS 表现为霹雳性头痛伴可逆性多灶性脑动脉狭窄，常见于中年女性。无头痛的 RCVS 较为罕见。RCVS 应作为无头痛的多发性脑动脉狭窄患者的鉴别诊断，连续 MRI 对其诊断很重要。医学研究杂志 71：323-326，2024 年 8 月。
