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High-Resolution Magnetic Resonance Imaging Findings of Reversible Cerebral Vasoconstriction Syndrome associated with Severe Anemia: A Case Report

중증 빈혈과 관련된 가역적 뇌혈관 수축 증후군의 고해상도 자기공명영상 소견: 증례 보고

  • Yongsang Kim (Department of Radiology, Nowon Eulji Medical Center, Eulji University College of Medicine) ;
  • Ra Gyoung Yoon (Department of Radiology, Nowon Eulji Medical Center, Eulji University College of Medicine) ;
  • Ji Ye Lee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Jong-Moo Park (Department of Neurology, Nowon Eulji Medical Center, Eulji University College of Medicine)
  • 김용상 (을지대학교 의과대학 노원을지대학교병원 영상의학과) ;
  • 윤라경 (을지대학교 의과대학 노원을지대학교병원 영상의학과) ;
  • 이지예 (서울대학교 의과대학 서울대학교병원 영상의학과) ;
  • 박종무 (을지대학교 의과대학 노원을지대학교병원 신경과)
  • Received : 2020.02.18
  • Accepted : 2020.05.07
  • Published : 2021.01.01

Abstract

Ischemic stroke is one of the manifestations of reversible cerebral vasoconstriction syndrome (RCVS). Many precipitants and associated disorders of RCVS have been suggested. However, few case reports have indicated an association between anemia and RCVS. Here, we report a case of a 66-year-old female with severe iron deficiency anemia (IDA), who presented with ischemic stroke and cerebral vasoconstriction, which gradually improved with conservative treatment. High-resolution vessel wall magnetic resonance imaging findings and reversibility suggested the possibility of RCVS. In patients with RCVS and ischemic stroke, IDA should be considered. Prompt management should be delivered to prevent disease progression and recurrence.

가역적 뇌혈관 수축 증후군은 허혈성 뇌졸중을 야기할 수 있으며 다양한 질환이 원인이 된다. 하지만 빈혈과 가역적 뇌혈관 수축 증후군의 연관성을 나타내는 사례 보고는 거의 없다. 이에 저자들은 보존적 치료로 호전된 66세 여성의 허혈성 뇌졸중과 뇌혈관 수축을 동반한 중증 철결핍빈혈의 사례를 보고하고자 한다. 고해상도 혈관벽 자기공명영상 소견 및 뇌혈관 협착의 가역성을 토대로 가역적 뇌혈관 수축 증후군을 진단할 수 있었다. 가역적 뇌혈관 수축 증후군 및 허혈성 뇌졸중을 가진 환자에서 철결핍빈혈은 하나의 원인으로 고려되어야 하며 즉각적인 처치를 통해 질병의 진행 및 재발을 방지해야 한다.

Keywords

References

  1. Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med 2007;146:34-44
  2. Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol 2012;11:906-917
  3. Huh JY, Kwak I, An SS, Lee J, Lee BC, Oh MS. Reversible cerebral vasoconstriction syndrome associated with severe anemia. J Korean Neurol Assoc 2018;36:246-248
  4. Lee JS, Park JK, Kim SH, Jeong SY. Reversible cerebral vasoconstriction syndrome: a case report. J Korean Soc Radiol 2013;69:343-346
  5. Singhal AB, Hajj-Ali RA, Topcuoglu MA, Fok J, Bena J, Yang D, et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 2011;68:1005-1012
  6. Chen SP, Fuh JL, Wang SJ, Chang FC, Lirng JF, Fang YC, et al. Magnetic resonance angiography in reversible cerebral vasoconstriction syndromes. Ann Neurol 2010;67:648-656
  7. Obusez EC, Hui F, Hajj-Ali RA, Cerejo R, Calabrese LH, Hammad T, et al. High-resolution MRI vessel wall imaging: spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis. AJNR Am J Neuroradiol 2014;35:1527-1532
  8. Ducros A, Boukobza M, Porcher R, Sarov M, Valade D, Bousser MG. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain 2007;130:3091-3101
  9. Ogata T, Kamouchi M, Kitazono T, Kuroda J, Ooboshi H, Shono T, et al. Cerebral venous thrombosis associated with iron deficiency anemia. J Stroke Cerebrovasc Dis 2008;17:426-428
  10. Ciufetti G, Lombardini R. Hyperviscosity syndromes. In Chang JB, ed. Textbook of angiology. New York: Springer 2000:478-491