Yao Xuefan, Li Yuzhe, He Aini, Zhao Benke, Sun Wei, Wu Xiao, Song Haiqing
Department of Neurology, Xuanwu Hospital, Capital Medicine University, Beijing, China.
Department of Neurology, Jixi Hospital of Traditional Chinese Medicine, Jixi, Heilongjiang, China.
Curr Med Imaging. 2025 Jun 17. doi: 10.2174/0115734056366051250604054327.
Reversible cerebral vasoconstriction syndrome (RCVS) is a condition characterized by thunderclap headaches, which are sudden and severe headaches that peak within a few seconds. These headaches present diagnostic difficulties due to their diversity and low specificity, often leading to misdiagnoses and patient dissatisfaction.
We present the case of a 52-year-old woman with a 10-day history of recurrent thunderclap headaches. Initial imaging revealed no abnormalities, but she experienced further episodes of thunderclap headaches during hospitalization. Subsequent neurovascular imaging revealed multiple intracranial stenoses with a "string of beads" appearance, confirming the diagnosis of reversible cerebral vasoconstriction syndrome. She was treated with nimodipine, and most symptoms had resolved upon discharge, with no recurrence of headache reported during a 3-month follow-up.
Prior reviews on reversible cerebral vasoconstriction syndrome predominantly emphasized isolated symptoms or advanced neuroimaging findings, offering limited applicability in primary care services. More attention should be given to identifying clinical manifestations warranting heightened reversible cerebral vasoconstriction syndrome suspicion.
Early recognition of reversible cerebral vasoconstriction syndrome counts in primary care services. We proposed a revised diagnostic routine that begins with clinical suspicion prompted by typical manifestations, like recurrent thunderclap headaches, female sex, and specific triggers, and recommends advanced neurovascular imaging when accessible. Extreme headache severity or deviation from prior migraine patterns should raise suspicion for reversible cerebral vasoconstriction syndrome, while diagnostic consideration should still remain in patients with transient neurological deficits, seizures, or cerebrovascular events.
可逆性脑血管收缩综合征（RCVS）是一种以霹雳样头痛为特征的疾病，霹雳样头痛是指突发的剧烈头痛，在几秒钟内达到峰值。这些头痛因其多样性和低特异性而存在诊断困难，常常导致误诊和患者不满。
我们报告一例52岁女性，有10天复发性霹雳样头痛病史。初始影像学检查未发现异常，但她在住院期间又出现了霹雳样头痛发作。随后的神经血管影像学检查显示多处颅内狭窄呈“串珠样”外观，确诊为可逆性脑血管收缩综合征。她接受了尼莫地平治疗，出院时大多数症状已缓解，在3个月的随访中未报告头痛复发。
先前关于可逆性脑血管收缩综合征的综述主要强调孤立的症状或先进的神经影像学检查结果，在初级保健服务中的适用性有限。应更加关注识别值得高度怀疑可逆性脑血管收缩综合征的临床表现。
在初级保健服务中早期识别可逆性脑血管收缩综合征很重要。我们提出了一种修订后的诊断程序，该程序始于由典型表现（如复发性霹雳样头痛、女性以及特定诱因）引发的临床怀疑，并在可进行检查时推荐先进的神经血管影像学检查。极度严重的头痛或与既往偏头痛模式不符应引起对可逆性脑血管收缩综合征的怀疑，而对于有短暂性神经功能缺损、癫痫发作或脑血管事件的患者仍应进行诊断性考虑。
