可逆性脑血管收缩综合征60例临床分析  

Clinical analysis of reversible cerebral vasoconstriction syndrome in 60 patients

作　　者：陈素芬[1] 唐建生 胡珏 宋康平 李璋麟 CHEN Sufen;TANG Jiansheng;HU Jue;SONG Kangping;LI Zhanglin(The Affiliated Changsha Central Hospital,University of South China,Changsha 410004,China)

机构地区：[1]南华大学附属长沙中心医院,湖南长沙410004

出　　处：《中国实用神经疾病杂志》2025年第3期300-304,共5页Chinese Journal of Practical Nervous Diseases

基　　金：湖南省自然科学基金项目(编号:2023JJ40072)。

摘　　要：目的分析可逆性脑血管收缩综合征(RCVS)的临床特征和预后。方法收集2014-01—2024-02国内外期刊报道的中国籍RCVS病例,结合南华大学附属长沙中心医院诊治的2例患者,回顾性分析纳入患者的临床资料。结果共纳入60例RCVS患者,发病年龄在20~64(40.7±12.8)岁,60%在40岁以前发病。最常见的诱因是沐浴,最常见的首发症状是反复发作性霹雳性头痛,多伴血压升高、恶心呕吐、痫性发作、偏侧肢体乏力、视力障碍、言语障碍、认知障碍。可表现为双侧头痛或单侧头痛,头痛部位无差异(P<0.05)。约5%的患者病程中无头痛出现。37例患者疾病早期行头颅MRA/CTA,发现颅内动脉弥漫性节段性狭窄者24例,前循环节段性狭窄者9例,后循环节段性狭窄者2例,颅内动脉正常颅外血管节段性狭窄者2例,仅10例患者DSA证实脑动脉多发局灶性狭窄。58例患者给予尼莫地平治疗,2例避免诱因未予药物治疗,随访时所有患者症状及血管影像异常均完全恢复。结论RCVS患者以40岁以下女性多发,多以反复发作霹雳性头痛为首发症状,可伴血压升高、恶心呕吐、痫性发作及局灶性神经功能缺损症状,也可全程无头痛,颅内外血管均可受累,尼莫地平治疗预后良好。Objective To analyze the clinical features and prognosis of reversible cerebral vasoconstriction syndrome(RCVS)patients.Methods The clinical data of Chinese RCVS cases reported in domestic and foreign journals from January 2014 to February 2024 were collected,combined with 2 cases diagnosed and treated in the Affiliated Changsha Central Hospital,University of South China.Results There were 60 RCVS patients in all.The age of onset is 20-64(40.7±12.8)years old.Sixty percent of the patients suffered from RCVS before the age of 40.The most common trigger is bathing,and the most common initial symptom is recurrent thunderclap headache,often accompanied by elevated blood pressure,nausea and vomiting,epileptic seizures,unilateral limb weakness,visual impairment,speech impairment,and cognitive impairment.They had bilateral headache or unilateral headache.There was no significant difference in headache location(P<0.05).Five percent of the patients have no headache during the disease.Thirty-seven patients performed MRA/CTA.There were 24 cases with diffuse segmental stenosis of intracranial arteries,9 cases with anterior circulation segmental stenosis,2 cases with posterior circulation segmental stenosis,and 2 cases with abnormal extracranial vascular.Only ten patients performed digital subtraction angiography(DSA)to confirm multiple focal cerebral artery stenosis.Fifty-eight patients were treated with nimodipine,while 2 cases did not receive medication but avoided the cause.All the patients of the clinical symptoms and vascular imaging abnormalities thoroughly restored.Conclusion The incidence is higher in women under the age of 40 in the patients with RCVS.Recurrent thunderclap headache is the most common initial symptom.It may be accompany by symptoms such as elevated blood pressure,nausea and vomiting,epileptic seizures,and focal neurological deficits.There may also be no headache throughout the disease process.Both intracranial and extracranial vascular may be affected.It’ll receive a good prognosis by nimodipine.

关 键 词：可逆性脑血管收缩综合征 霹雳性头痛 临床表现 血管影像 预后 

分 类 号：R741.041[医药卫生—神经病学与精神病学]