摘要
目的报告1例临床罕见的可逆性脑血管收缩综合征病例，以期提高对该病的认识。方法对1例可逆性脑血管收缩综合征患者的临床症状、影像学特征及临床转归进行回顾性分析，并复习相关文献。结果女性患者，25岁。以声音刺激后发作性、雷击样、剧烈头痛为首发症状，继之出现右侧肢体无力，症状持续。MRI检查显示右侧外囊、左侧枕叶及左侧额顶叶皮质多发长T1、长T2信号；TCD检查显示双侧颈内动脉末端、大脑中动脉血流速度明显增快伴涡流、杂音，提示血管狭窄；MRA检查双侧大脑前动脉、大脑中动脉、大脑后动脉呈节段性狭窄，似“串珠样”改变。经氯吡格雷、羟乙基淀粉和维生素B1治疗后，临床症状完全恢复。出院后复查TCD显示血流速度和频谱基本正常，MRI显示病灶明显缩小，MRA可见血管形态恢复正常。临床诊断为可逆性脑血管收缩综合征。结论临床表现为雷击样头痛的患者应考虑可逆性脑血管收缩综合征的可能，其继发性脑梗死易发生于大脑后循环供血区和分水岭区。TCD和MRA检查可作为诊断、药物疗效评价及随访观察的重要方法。
Objective To review one case of reversible cerebral vasoconstriction syndrome （RCVS） and to recognize this disease. Methods Retrospectively analysed the clinical presentation, neuroimaging features and outcomes of one case with RCVS and reviewed related literatures. Results A 25-year-old woman was admitted because of the onset of acute severe paroxysmal thunderclap headache induced by sound stimulation at first and occurrence of right hemiparesis 2 weeks later. She had family history of migraine. Physical examination showed that the right muscle force was 4 level and left was 5. The symptoms existed persistently. Babinski sign was negative. Magnetic resonance imaging （MRI） showed infarction in the right external capsule and left occipital, frontopartial. Transcranial Doppler （TCD） demonstrated notable elevated blood flow velocities in bilateral terminal of internal carotid arteries and middle cerebral arteries. Magnetic resonance angiography （MRA） showed multifocal segmental narrowing of bilateral anterior, middle and posterior cerebral arteries. Infarction was diagnosed and clopidogrel, hydroxyethyl starch and vitamin B1 were given. The patient obtained a complete recovery of the symptom. Follow-up TCD demonstrated normalization of cerebral blood flow velocities and frequency spectrum one month later. After 3 months the infarction on MRI were apparently reduced in size and the vessel lumina became normal on MRA. The clinical diagnosis was reversible cerebral vasoconstriction syndrome. Conclusion RCVS should be considered in patients with re- current thunderclap headache. Although the vasoconstriction involves the circle of Willis, area supplied by the posterior circulation and watershed region are more likely to develop secondary infarction. TCD and MRA can be significant reliable non-invasive measures for diagnosis, therapeutic assessment, and follow-up examination in RCVS.
出处
《中国现代神经疾病杂志》
CAS
2009年第1期31-34,共4页
Chinese Journal of Contemporary Neurology and Neurosurgery
关键词
大脑动脉环
血管痉挛
颅内
超声检查
多普勒
经颅
磁共振成像
Circle of Willis
Vasospasm, intracranial
Ultrasonography, Doppler, transcranial
Magnetic resonance imaging
