Postpartum reversible cerebral vasoconstriction with cortical subarachnoid hemorrhage and posterior reversible encephalopathy syndrome concomitant with vertebral artery dissection diagnosed by MRI MSDE method: A case report and review of literature.
头痛是产后最常见的症状之一。其病因可能不明，也可能为以下疾病：颈动脉夹层（CAD）、可逆性后部脑病综合征（PRES）和可逆性脑血管收缩综合征（RCVS）。有观点认为这些疾病相互关联，并具有相似的机制，如小血管内皮功能障碍、自我调节缺陷以及后循环交感神经支配减少。然而，关于神经影像学发现的报道很少。我们经历了一例罕见的产后多种血管疾病同时发生的病例。一名38岁女性在分娩后突然出现雷击样头痛。她意识清楚，无神经病变。计算机断层扫描显示蛛网膜下腔出血，包括额叶皮质表面。磁共振液体衰减反转恢复序列显示双侧基底节和右侧枕叶皮质高信号区。血管造影显示“串珠样”改变及左侧颅外椎动脉狭窄，但未见动脉瘤。根据临床病程和神经影像学发现，我们诊断她为产后血管疾病，包括CAD、PRES、RCVS和皮质蛛网膜下腔出血（SAH）。采用运动敏感驱动平衡三维涡轮自旋回波（MSDE）序列的三维黑血T1加权成像显示与颅外椎动脉一致的血肿。3个月后，MSDE异常信号消失。我们的病例之所以罕见，在于产后血管疾病的多种现象同时发生。特别是，我们能够通过MRI MSDE序列揭示这一推测是可逆的。
Headache is one of the most common symptoms encountered during the postpartum period. The cause may be unknown, or the following illnesses are possible: cervical artery dissection (CAD), reversible posterior cerebral encephalopathy syndrome (PRES), and reversible cerebral vasoconstrictor syndrome (RCVS). It is suggested that they are interrelated and share a similar mechanism such as small vessel endothelial dysfunction, deficiencies in self-regulation, and decreased sympathetic innervation of the posterior circulation. However, there are few reports of neuroradiological findings. We experienced a rare case of multiple postpartum vascular disease occurring at the same time. A 38-year-old woman suddenly developed thunderclap headache after giving birth. She was clear and had no neuropathy. Computed tomography revealed subarachnoid hemorrhage, including the cortical surface of the frontal lobe. Magnetic resonance image fluid-attenuated inversion recovery revealed high-intensity area in the bilateral basal ganglia and right occipital cortex. Angiography showed "string sausage" and extracranial left vertebral artery stenosis, but no aneurysm. Based on the clinical course and neuroradiological findings, we diagnosed her as postpartum vascular disease including CAD, PRES, RCVS, and cortical subarachnoid hemorrhage (SAH). Three-dimensional black blood T1-weighted images using a motion-sensitized driven equilibrium three-dimensional turbo spin echo (MSDE) sequencing method revealed an intramural hematoma consistent with the extracranial vertebral artery. After 3 months, MSDE lost its abnormal signal. Our case was rare in that multiple phenomena of postpartum vascular disease occurred at the same time. In particular, we could reveal that this speculation was reversible in the MRI MSDE sequencing.
Kenshi Sano, Atsushi Kuge, Rei Kondo, Tetsu Yamaki, Hiroshi Homma, Shinjiro Saito, et al. Postpartum reversible cerebral vasoconstriction with cortical subarachnoid hemorrhage and posterior reversible encephalopathy syndrome concomitant with vertebral artery dissection diagnosed by MRI MSDE method: A case report and review of literature.. Clinical case reports. 2022; doi:10.1002/ccr3.6257.
Kenshi Sano, Atsushi Kuge, Rei Kondo, Tetsu Yamaki, Hiroshi Homma, Shinjiro Saito, et al (2022). Postpartum reversible cerebral vasoconstriction with cortical subarachnoid hemorrhage and posterior reversible encephalopathy syndrome concomitant with vertebral artery dissection diagnosed by MRI MSDE method: A case report and review of literature.. Clinical case reports. https://doi.org/10.1002/ccr3.6257
Kenshi Sano, Atsushi Kuge, Rei Kondo, Tetsu Yamaki, Hiroshi Homma, Shinjiro Saito, et al. Postpartum reversible cerebral vasoconstriction with cortical subarachnoid hemorrhage and posterior reversible encephalopathy syndrome concomitant with vertebral artery dissection diagnosed by MRI MSDE method: A case report and review of literature.[J]. Clinical case reports, 2022 doi:10.1002/ccr3.6257.
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