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Reversible Cerebral Vasoconstriction Syndrome in Hellp Syndrome
並列摘要
Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe and hyperacute headaches with or without additional focal neurological deficits, and evidence of vasoconstriction of cerebral arteries which resolves spontaneously within 1-3 months. However, the precise mechanism of RCVS is not fully understood. Case Report: We report a 33-year-old postpartum woman with RCVS with HELLP syndrome and eclampsia. Magnetic resonance angiography (MRA) of head revealed transient segmental stenosis and dilatation. Especially, most part of the middle cerebral artery (MCA) was irregularly thinner at the acute phase than have ever previously reported. Transcranial color flow imaging (TCFI) showed the highest peak systolic velocity of middle cerebral artery that has ever reported in RCVS cases (330 cm/s). Histologically, the large areas that showed cytotoxic edema on magnetic resonance imaging at acute phase, which indicated possible infarction at the chronic stage, have eventually become normal in chronic stage. Conclusion: This RCVS case occurred to a postpartum woman in HELLP syndrome after eclampsia. The peak velocity of MCA measured by TCFI was the highest so far ever reported in RCVS cases, and vasoconstriction on MRA was severe. However, the severe vasoconstriction did not last long enough to cause infarction in brain tissue in this case. TCFI also shows the steep decline of the peak velocity of MCA after acute phase and through this case we reconfirm the usefulness of TCFI as this bed-side test reflects quite well the changes of vasoconstriction in severe RCVS case.
延伸閱讀
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