頭痛為家庭醫學科門診很常見的病人主訴，完整的病史詢問及理學檢查會協助我們判別危急的頭痛徵象，而其中雷擊性頭痛(thunderclap headache, TCH)就是不容忽視的警訊之一。此個案報告分享一位有偏頭痛病史的病人，新發生TCH，在排除其它鑑別診斷後，診斷為可逆性腦血管收縮症候群(reversible cerebral vasoconstriction syndrome, RCVS)。本文針對TCH常見的鑑別診斷及RCVS做簡要的文獻回顧，讓基層醫療醫師對此頭痛主訴及診斷能有所警惕，以做出適當的處置及轉診。
(台灣家醫誌2024; 34: 177-184) DOI: 10.53106/168232812024093403007

關鍵詞：可逆性腦血管收縮症候群、雷擊性頭痛

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¹新竹馬偕紀念醫院家庭醫學科
²新光吳火獅紀念醫院神經內科
受理日期：113年1月10日   修改日期：113年2月14日   同意刊登：113年3月15日
^*通訊作者：林冠佑              通訊地址：台北市士林區文昌路95號 新光吳火獅紀念醫院神經內科
E-mail: alexlingy0315@hotmail.com
 

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Reversible Cerebral Vasoconstriction Syndrome: A Case Report and Literature Review

Chien-Ju Lin¹ and Kuan-Yu Lin^2*
 

Headache is a common chief complaint in family medicine clinics. Careful history-taking and physical examination help establish critical headache diagnosis, and thunderclap headache (TCH) is one of the red flag features of headache. This article reported a female patient with a history of episodic migraine who developed new TCH and was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) after excluding other differential diagnoses. The literature on the evaluation of TCH and diagnosis of RCVS were reviewed herein. This case report may help primary care physicians to be alert to TCH and RCVS for appropriate treatment and referral.
(Taiwan J Fam Med 2024; 34: 177-184) DOI: 10.53106/168232812024093403007
 
Key words: reversible cerebral vasoconstriction syndrome, thunderclap headache

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¹Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan.
²Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Received: January 10, 2024; Revised: February 14, 2024; Accepted: March 15, 2024.
^*Corresponding author