Journal of Korean Neurosurgical Society

  • 제56권5호
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  • Pages.419-422
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  • 2014
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Progressive Manifestations of Reversible Cerebral Vasoconstriction Syndrome Presenting with Subarachnoid Hemorrhage, Intracerebral Hemorrhage, and Cerebral Infarction

  • Choi, Kyu-Sun (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Yi, Hyeong-Joong (Department of Neurosurgery, Hanyang University Medical Center)
  • 투고 : 2013.09.12
  • 심사 : 2014.01.15
  • 발행 : 2014.11.28
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초록

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset headache with focal neurologic deficit and prolonged but reversible multifocal narrowing of the distal cerebral arteries. Stroke, either hemorrhagic or ischemic, is a relatively frequent presentation in RCVS, but progressive manifestations of subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction in a patient is seldom described. We report a rare case of a 56-year-old woman with reversible cerebral vasoconstriction syndrome consecutively presenting as cortical subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction. When she complained of severe headache with subtle cortical subarachnoid hemorrhage, her angiography was non-specific. But, computed tomographic angiography showed typical angiographic features of this syndrome after four days. Day 12, she suffered mental deterioration and hemiplegia due to contralateral intracerebral hematoma, and she was surgically treated. For recurrent attacks of headache, medical management with calcium channel blockers has been instituted. Normalized angiographic features were documented after 8 weeks. Reversible cerebral vasoconstriction syndrome should be considered as differential diagnosis of non-aneurysmal subarachnoid hemorrhage, and repeated angiography is recommended for the diagnosis of this under-recognized syndrome.

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참고문헌

  1. Ansari SA, Rath TJ, Gandhi D : Reversible cerebral vasoconstriction syndromes presenting with subarachnoid hemorrhage : a case series. J Neurointerv Surg 3 : 272-278, 2011 https://doi.org/10.1136/jnis.2010.004242
  2. Bouchard M, Verreault S, Gariepy JL, Dupre N : Intra-arterial milrinone for reversible cerebral vasoconstriction syndrome. Headache 49 : 142-145, 2009 https://doi.org/10.1111/j.1526-4610.2008.01211.x
  3. Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB : Narrative review : reversible cerebral vasoconstriction syndromes. Ann Intern Med 146 : 34-44, 2007 https://doi.org/10.7326/0003-4819-146-1-200701020-00007
  4. Calabrese LH, Gragg LA, Furlan AJ : Benign angiopathy : a distinct subset of angiographically defined primary angiitis of the central nervous system. J Rheumatol 20 : 2046-2050, 1993
  5. Call GK, Fleming MC, Sealfon S, Levine H, Kistler JP, Fisher CM : Reversible cerebral segmental vasoconstriction. Stroke 19 : 1159-1170, 1988 https://doi.org/10.1161/01.STR.19.9.1159
  6. Chen SP, Fuh JL, Lirng JF, Chang FC, Wang SJ : Recurrent primary thunderclap headache and benign CNS angiopathy : spectra of the same disorder? Neurology 67 : 2164-2169, 2006 https://doi.org/10.1212/01.wnl.0000249115.63436.6d
  7. Ducros A, Fiedler U, Porcher R, Boukobza M, Stapf C, Bousser MG : Hemorrhagic manifestations of reversible cerebral vasoconstriction syndrome : frequency, features, and risk factors. Stroke 41 : 2505-2511, 2010 https://doi.org/10.1161/STROKEAHA.109.572313
  8. Elstner M, Linn J, Müller-Schunk S, Straube A : Reversible cerebral vasoconstriction syndrome : a complicated clinical course treated with intra-arterial application of nimodipine. Cephalalgia 29 : 677-682, 2009 https://doi.org/10.1111/j.1468-2982.2008.01768.x
  9. Hajj-Ali RA, Furlan A, Abou-Chebel A, Calabrese LH : Benign angiopathy of the central nervous system : cohort of 16 patients with clinical course and long-term followup. Arthritis Rheum 47 : 662-669, 2002 https://doi.org/10.1002/art.10797
  10. Hantson P, Forget P : Reversible cerebral vasospasm, multilobular intracerebral hemorrhages, and nonaneurysmal subarachnoid hemorrhage : review of possible interrelationships. Curr Pain Headache Rep 14 : 228-232, 2010 https://doi.org/10.1007/s11916-010-0106-x
  11. Moskowitz SI, Calabrese LH, Weil RJ : Benign angiopathy of the central nervous system presenting with intracerebral hemorrhage. Surg Neurol 67 : 522-527; discussion 527-528, 2007 https://doi.org/10.1016/j.surneu.2006.07.026
  12. Nadeau SE : Diagnostic approach to central and peripheral nervous system vasculitis. Neurol Clin 15 : 759-777, 1997 https://doi.org/10.1016/S0733-8619(05)70346-7
  13. Noskin O, Jafarimojarrad E, Libman RB, Nelson JL : Diffuse cerebral vasoconstriction (Call-Fleming syndrome) and stroke associated with antidepressants. Neurology 67 : 159-160, 2006 https://doi.org/10.1212/01.wnl.0000223648.76430.27
  14. Quartuccio L, Tuniz F, Petralia B, Zanotti B, Skrap M, Vita SD : Delayed positivization of cerebral angiography in reversible cerebral vasoconstriction syndrome (RCVS) presenting with recurrent subarachnoid haemorrhage. Open Rheumatol J 6 : 175-179, 2012 https://doi.org/10.2174/1874312901206010175
  15. Refai D, Botros JA, Strom RG, Derdeyn CP, Sharma A, Zipfel GJ : Spontaneous isolated convexity subarachnoid hemorrhage : presentation, radiological findings, differential diagnosis, and clinical course. J Neurosurg 109 : 1034-1041, 2008 https://doi.org/10.3171/JNS.2008.109.12.1034
  16. Shah AK : Non-aneurysmal primary subarachnoid hemorrhage in pregnancy-induced hypertension and eclampsia. Neurology 61 : 117-120, 2003 https://doi.org/10.1212/01.WNL.0000069609.36517.A3
  17. Singhal AB, Hajj-Ali RA, Topcuoglu MA, Fok J, Bena J, Yang D, et al. : Reversible cerebral vasoconstriction syndromes : analysis of 139 cases. Arch Neurol 68 : 1005-1012, 2011 https://doi.org/10.1001/archneurol.2011.68
  18. Spitzer C, Mull M, Rohde V, Kosinski CM : Non-traumatic cortical subarachnoid haemorrhage : diagnostic work-up and aetiological background. Neuroradiology 47 : 525-531, 2005 https://doi.org/10.1007/s00234-005-1384-6
  19. Sturm JW, Macdonell RA : Recurrent thunderclap headache associated with reversible intracerebral vasospasm causing stroke. Cephalalgia 20 : 132-135, 2000 https://doi.org/10.1046/j.1468-2982.2000.00053.x
  20. van Gijn J, Rinkel GJ : Subarachnoid haemorrhage : diagnosis, causes and management. Brain 124 (Pt 2) : 249-278, 2001 https://doi.org/10.1093/brain/124.2.249

피인용 문헌

  1. Decompression Hemicraniectomy for Refractory Intracranial Hypertension in Reversible Cerebral Vasoconstriction Syndrome vol.10, pp.2, 2019, https://doi.org/10.4103/jnrp.jnrp_334_18