젊은 연령 환자에서 지주막하 출혈의 원인 질환인 가역적 뇌혈관수축증후군

초록

Purpose Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by a sudden onset of thunderclap-like headache, with or without focal neurological deficits, and seizures, most commonly in young aged 20-50 years. The authors present three cases of RCVS patients who developed spontaneous convexity subarachnoid hemorrhage (SAH). Materials and methods From 2012 to 2015 medical records and radiological findings were analyzed in three patients who diagnose of RCVS. Two patients were in forties, and one for fifties, and all the patients visited emergency room presenting sudden thunderclap-like headache. Results The patients showed following characteristics. 1) convexity SAH in unilateral hemisphere on computerized tomography (CT) scan, 2) all the patients showed focal neurological deficit one to five hours later following headache, 3) two patients showed only SAH, and the one showed SAH with cerebral infarction on magnetic resonance (MR) images, 4) completely resolved vasoconstriction on follow up angiography 4 or 6 weeks later, and 4) benign clinical courses. Conclusion In convexity SAH without evidence of aneurysmal rupture or arteriovenous malformation in young patients, neurosurgeons should keep in mind RCVS as a differential diagnosis.