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Case No. 315
2013-09-02~2013-09-30
출제자 : 차지훈
Hit : 361
| Period | 2013-09-02~2013-09-30 |
|---|---|
| Diagnosis | RCVS (Reversible cerebral vasoconstriction syndrome) |
| Clinical information | F/33 CC: Patient with peripartum status. S/P Eclampsia, 진단은? |
| Discussion | 답: RCVS (Reversible cerebral vasoconstriction syndrome) 해설 Reversible cerebral vasoconstriction syndrome (RCVS) is characterised by the association of severe headaches (thunderclap headache) with or without (c/s) additional neurological symptoms, and constriction of cerebral arteries which resolves spontaneously in 1–3 months. major complications are localised cortical subarachnoid haemorrhages (20–25%) and ischaemic or haemorrhagic strokes (5–10%). Mechanism - unknown - may associateed with transient disturbance in the control of cerebral vascular tone leading to segmental and multifocal arterial constriction and dilatation. Patient demographics - Age 13-70 years - F:M = 2~10:1 - Associated condition : postpartum c/s eclampsia/pre-eclamptia, vasoactive substance (cannabis, ecstasy, amphetamine, ergotamine, etc), catecholamine secreting tumor, immunosuppressant, etc. Imaging - feature of PRES (posterior reversible encephalopathy syndrome) (10%) - localised cortical SAH (20%), ICH (6%) - borderzone infarction (4%) - angiography (MRA, CTA or catheter) : multifocal segmental narrowing and dilatation (string of beads / sausage strings) of medium to large sized cerebral artery (100%) - mostly resolve in 3 months c/s sequelae Treatment Analegesics, antiepleptic drug for any seizure, avoid vasoactive substance, nimodipine |
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