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Ⅰ.はじめに
若年性虚血性脳血管障害の原因として動脈解離1,7,9),もやもや病,片頭痛,薬物乱用,reversible cerebral vasoconstriction syndrome(RCVS)2,4,6,9,11),抗リン脂質抗体症候群や全身性エリテマトーデスなどの自己免疫性疾患など,何らかの基礎疾患を有することが多い5,12).
しかし今回われわれは,明らかな基礎疾患を有さず,激しい頭痛と早期の可逆性脳血管攣縮所見からRCVSと診断した症例を経験したので,経時的に大きく変化する血管撮影を示し,文献的考察を加えて報告する.
A 19-year-old woman had a thunderclap headache, followed by left hemiparesis and left homonymous hemianopsia. Laboratory tests showed no signs of infection and immunological test results were unremarkable. MRI revealed a cerebral infarction in the right posterior cerebral artery territory, and digital subtraction angiography(DSA)showed right posterior cerebral artery stenosis on day 2. The first follow-up DSA demonstrated an irregular, bead-like appearance on day 9, but the stenotic lesion returned to normal on day 21.
Reversible cerebral vasoconstriction syndrome should be suspected in cases of rapid resolution of symptoms.
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