Reversible Cerebral Vasoconstriction Syndromes: What the Cardiologist Should Know
Reversible Cerebral Vasoconstriction Syndromes: What the Cardiologist Should Know
复制标题
可逆性脑血管收缩综合征：心脏病专家应该知道什么
DOI：
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发表时间：
2014
影响因子：
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通讯作者：
A. Singhal
中科院分区：
文献类型：
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作者：
A. Singhal
在过去的十年里，可逆性脑血管收缩综合征(RCVS)作为一组易于识别的临床血管造影特征和通常良好的预后而出现。RCVS影响年轻人，主要是女性，大多数人表现出反复出现的严重的雷鸣般的头痛。血管成像研究显示脑内多条动脉动态和可逆性狭窄和扩张。脑成像通常不显示实质性损害，然而，大约三分之一的患者发展为缺血性或出血性中风或可逆性脑水肿。该综合征的发病机制尚不清楚。它与多种情况有关，如怀孕、血管收缩药物的使用和神经血管手术。最近对RCVS的研究表明，排除动脉瘤性蛛网膜下腔出血和中枢神经系统的原发性血管炎等类似疾病相对容易。目前还没有得到证实的治疗方法，尽管钙通道阻滞剂可能有助于减轻头痛的强度。应避免经验性糖皮质激素治疗。由于大多数患者仅通过简单的观察就能做好，侵入性策略，如药物性高血压、球囊血管成形术和直接动脉内血管扩张剂输注，应该保留给临床进展明显的患者。
Opinion statementOver the past decade, the reversible cerebral vasoconstriction syndromes (RCVS) have emerged as a group of conditions with easily recognizable clinical-angiographic features and a usually benign prognosis. The RCVS affect young individuals, mostly women, and the majority present with recurrent, severe, ‘thunderclap’ headaches. Vascular imaging studies show dynamic and reversible narrowing and dilatation of multiple intracerebral arteries. Brain imaging usually shows no parenchymal lesions, however, approximately one-third of patients develop ischemic or hemorrhagic strokes or reversible brain edema. The etiopathogenesis of this syndrome remains unclear. It has been associated with diverse conditions such as pregnancy, vasoconstrictive drug use, and neurovascular procedures. Recent studies characterizing RCVS have made it relatively easy to exclude mimics such as aneurysmal subarachnoid hemorrhage and primary angiitis of the central nervous system. There is no proven treatment, although calcium channel blockers may help to reduce the intensity of headaches. Empiric glucocorticoid treatment should be avoided. Since most patients do well with simple observation alone, invasive strategies such as pharmacologically-induced hypertension, balloon angioplasty, and direct intra-arterial vasodilator infusion should be reserved for patients showing clear clinical progression.