Purpose

This study aimed to assess the evolution of imaging patterns over time in patients with neurological complications caused by reversible cerebral vasoconstriction syndrome.

Methods

A total of 24 consecutive patients with reversible cerebral vasoconstriction syndrome presenting between 2009 and 2016 were included, whose disease course was complicated by intracranial hemorrhage and/or ischemic events. In total 55 angiographic studies were carried out. The nature of the intracranial complication and location of vasoconstriction on the angiograms in relation to the time interval since symptom-onset were assessed.

Results

Complications included subarachnoid hemorrhage (n = 19, 79%), intracerebral hemorrhage (n = 7, 29%), ischemic stroke (n = 6, 25%), and transient ischemic attack (n = 4, 17%). Hemorrhagic complications mainly occurred within 7 days after symptom onset (18/19 patients, 95%), whereas ischemic events only occurred after the first week (10/10 patients, 100%, p < 0.00001). Distal vasospasm was predominantly observed within 7 days (26/28 angiograms, 93%) and proximal vasospasm ≥7 days (23/27 angiograms, 85%, p < 0.00001).

Conclusion

In reversible cerebral vasoconstriction syndrome causing neurological complications, an early hemorrhagic phase with distal vasospasm and a delayed ischemic phase with proximal vasospasm can be discriminated.

中文翻译：

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可逆性脑血管收缩综合征出血和缺血期的血管造影特征。

目的

这项研究旨在评估可逆性脑血管收缩综合征引起的神经系统并发症患者的成像模式随时间的演变。

方法

纳入2009年至2016年之间连续出现的24例可逆性脑血管收缩综合征的患者，其病程并发颅内出血和/或缺血事件。总共进行了55次血管造影研究。评估自症状发作以来的时间间隔，颅内并发症的性质和血管造影上血管收缩的位置。

结果

并发症包括蛛网膜下腔出血（n  = 19，79％），脑出血（n  = 7、29％），缺血性中风（n  = 6、25％）和短暂性脑缺血发作（n  = 4、17％）。出血性并发症主要发生在症状发作后的7天内（18/19例患者，占95％），而缺血性事件仅在第一周后发生（10/10例患者，占100％，p  <0.00001）。远端血管痉挛主要在7天内观察到（26/28血管造影，占93％），近端血管痉挛≥7天（23/27血管造影，占85％，p  <0.00001）。

结论

在引起神经系统并发症的可逆性脑血管收缩综合征中，可以区分出远端血管痉挛的早期出血期和近端血管痉挛的延迟缺血期。