J-STAGE 原著要旨 5 reversible cerebral vasoconstriction syndrome RCVS posterior reversible encephalopathy syndrome PRES RCVS PRES Key

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1 原著要旨 5 reversible cerebral vasoconstriction syndrome RCVS posterior reversible encephalopathy syndrome PRES RCVS PRES Key words: pregnancy-associated stroke, cortical subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome 背景および目的 /10 1, ADL 5 対象および方法結果 doi: /jstroke Fig. 1 5 Table

2 Fig. 1 Axial CT and FLAIR images revealed c-sah (arrow) in all cases. Clinical features Table 1 Clinical features and radiological findings Case 1 Case 2 Case 3 Case 4 Case 5 age past pregnancy history G2P1IA1 P1 G2P1SA1 G1IA1 G1SA1 past medical history uterine myoma PIH PIH, HEELP ITP none pregnancy risk (score) high-risk (16) high-risk (7) high-risk (5) moderate-risk (3) low-risk (1) method of childbirth C/S C/S C/S natural C/S method of anesthesia spinal anesthesia epidural anesthesia spinal anesthesia spinal anesthesia none spinal anesthesia anesthetic bupivacaine bupivacaine bupivacaine none bupivacaine precipitating drugs of RCVS ephedrine, phenylephrine ergot alkaloid ephedrine ephedrine intravenous immunoglobulin ergot alkaloid timing of c-sah day 1 of PP day 1 of PP day 1 of PP day 3 of PP day 1 of PP symptoms headache (severe) headache (mild) convulsion convulsion headache (moderate) visual disturbance none headache (not available) convulsion mrs Radiological findings location of c-sah frontal and parietal lobe frontal lobe bilateral frontal lobe bilateral occipital lobe frontal lobe number of c-sah detection of vasoconstriction number of affected artery laterarity of affected artery day 6 after onset day 2 after onset day 6 after onset day 7 after onset day 7 after onset bilateral unilateral bilateral bilateral bileteral PRES ( ) ( + ) ( + ) ( ) ( + ) infarction ( + ) ( ) ( ) ( ) ( ) G: graviditas, P: parturition, IA: induced abortion, SA: spontaneous abortion, PIH: pregnancy induced hypertension, HEELP: hemolysis elevated liver enzyme low platelet syndrome, ITP: idiopathic thrombocytopenic purpura, C/S: cesarean section, PP: post partum, c-sah: cortical subarachnoid hemorrhage, PRES: posterior reversible encephalopathy syndrome 2

Fig. 2 MRA images for all cases performed day 2 to 7 after oneset. MRA images for cases 1 to 5 revealed multiple focal vasoconstrictions, which are characteristic of RCVS (arrow).

This topographic distribution pattern was identified as the characteristic pattern of PRES and classified as the central pattern.

3 Fig. 2 MRA images for all cases performed day 2 to 7 after oneset. MRA images for cases 1 to 5 revealed multiple focal vasoconstrictions, which are characteristic of RCVS (arrow). These vasoconstrictions improved within 12 weeks. Fig. 3 FLAIR images for cases developed PRES. The axial FLAIR images for cases 2, 3, and 5 revealed hyperintensity at the basal ganglia (arrow). This topographic distribution pattern was identified as the characteristic pattern of PRES and classified as the central pattern HELLP MRI reversible cerebral vasoconstriction syndrome RCVS Fig MRI posterior reversible encephalopathy syndrome PRES Fig Fig. 4 mrs 0 4 mrs 1 1 考察 RCVS RCVS 2007 Calabrese Call- Fleming syndrome post-partum angiopathy drug induced angiitis RCVS 5 RCVS 3

Fig. 4 Axial and coronal DWI of case 1. Case 1 developed brain infarction 6 days after c-sah developed and was finally discharged with an mrs 1 status.

4 Fig. 4 Axial and coronal DWI of case 1. Case 1 developed brain infarction 6 days after c-sah developed and was finally discharged with an mrs 1 status. arterial tone Case RCVS RCVS RCVS 5, 6 RCVS 5 RCVS , RCVS RCVS PRES PRES 1996 Hinchey 10 PRES PRES 14 11, 12 PRES 2 HELLP HELLP PRES RCVS RCVS 8 38 PRES PRES 80 RCVS RCVS PRES 8 10, 13 RCVS PRES RCVS PRES 14 RCVS 1 13 RCVS 92 7, 8, RCVS RCVS 13 1 RCVS 16 RCVS 13 RCVS mrs mrs RCVS RCVS mrs RCVS 18, 19 RCVS 4

5 20 Muehlschlegel RCVS 2 OR CI OR CI CTA MRA 結 RCVS PRES COI COI 語参考文献 1 James AH, Bushnell CD, Jamison MG, et al: Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol 106: , Tang CH, Wu CS, Lee TH, et al: Preeclampsia-eclampsia and the risk of stroke among peripartum in Taiwan. Stroke 40: , Takahashi JC, Iihara K, Ishii A, et al: Pregnancy-associated intracranial hemorrhage: results of a survey of neurosurgical institutes across Japan. J Stroke Cerebrovasc Dis 23: e65 71, Calabrese LH, Dodick DW, Schwedt TJ, et al: Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med 2; 146: 34 44, Wolff V, Ducros A: Reversible cerebral vasoconstriction syndrome without typical thunderclap headache. Headache 56: , Ducros A, Fiedler U, Porcher R, et al: Hemorrhagic manifestations of reversible cerebral vasoconstriction syndrome: frequency, features, and risk factors. Stroke 41: , Singhal AB, Hajj-Ali RA, Topcuoglu MA, et al: Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 68: , Kumar S, Goddeau RP Jr, Selim MH, et al: Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies. Neurology 16; 74: , Hinchey J, Chaves C, Appignani B, et al: A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334: , Liman TG, Bohner G, Heuschmann PU, et al: The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol 259: , Bartynski WS, Boardman JF: Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 28: , Ducros A: Reversible cerebral vasoconstriction syndrome. Lancet Neurol 11: , Hefzy HM, Bartynski WS, Boardman JF, et al: Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 30: , Chen SP, Fuh JL, Wang SJ, et al: Magnetic resonance angiography in reversible cerebral vasoconstriction syndromes. Ann Neurol 67: , Doss-Esper CE, Singhal AB, Smith MS, et al: Reversible posterior leukoencephalopathy, cerebral vasoconstriction, and strokes after intravenous immune globulin therapy in guillain-barre syndrome. J Neuroimaging 15: , Ducros A, Boukobza M, Porcher R, et al: The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome: a prospective series of 67 patients. Brain 130(Pt 12): , Lu SR, Liao YC, Fuh JL, et al: Nimodipine for treatment of primary thunderclap headache. Neurology 27; 62: , Nowak DA, Rodiek SO, Henneken S, et al: Reversible segmental cerebral vasoconstriction (Call-Fleming syndrome): are calcium channel inhibitors a potential treatment option? Cephalalgia 23: , Topcuoglu MA, Ogilvy CS, Carter BS, et al: Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests. J Neurosurg 98: , Muehlschlegel S, Kursun O, Topcuoglu MA, et al: Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol 70: ,

6 Abstract A descriptive study of 5 cases of cortical subarachnoid hemorrhage in pregnancy-associated stroke Junya Yamaguchi, M.D., 1) Takao Kojima, M.D., Ph.D., 2) Noriko Kato, M.D., Ph.D., 3) and Yukio Seki M.D., Ph.D. 2) 1) Department of Neurosurgery, Ichinomiya Municipal Hospital 2) Department of Neurosurgery, Nagoya Daini Red Cross Hospital 3) Department of Obstetrics and Gynecology, Nagoya Daini Red Cross Hospital Background and purpose: It is important to understand pregnancy-associated stroke because it is a major cause of maternal death. Cortical subarachnoid hemorrhage (c-sah) occurs in some patients with pregnancy-associated stroke, and the clinical course is relatively good. Methods: By reviewing the patients medical records, we retrospectively investigated 5 cases in which c-sah developed during pregnancy. Results: All patients developed c-sah during the postpartum period, and clinic-radiological findings of reversible cerebral vasoconstriction syndrome (RCVS) and/or posterior reversible encephalopathy syndrome (PRES) were noted. The prognosis in all cases was good. Conclusion: The development of c-sah during pregnancy could be associated with RCVS and PRES. Although the prognosis is relatively good, careful radiological follow-up is required. Key words: pregnancy-associated stroke, cortical subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome 6

日本職業・災害医学会会誌第51巻第5号

日本職業・災害医学会会誌第51巻第5号太田ら同時多発性高血圧性脳葉出血の 1 手術例図 1 搬入時 CT 上段単純 CT 下段造影 CT 図 2 術後の脳血管撮影検査では明らかな出血源は認めない 379 Reprint request: MULTIPLE SIMULTANEOUS HYPERTENSIVE LOBAR HEMORRHAGE Hirotsugu OHTA M.D. 1) and Akira YOKOTA M.D.

J-STAGE 原 著 要旨 5 reversible cerebral vasoconstriction syndrome RCVS posterior reversible encephalopathy syndrome PRES RCVS PRES Key

J-STAGE 原著要旨 5 reversible cerebral vasoconstriction syndrome RCVS posterior reversible encephalopathy syndrome PRES RCVS PRES Key