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Oikawa Y, Okubo Y, Numata-Uematsu Y, Aihara Y, Kitamura T, Takayanagi M, Takahashi Y, Kure S, Uematsu M. Initial vasodilatation in a child with reversible cerebral vasoconstriction syndrome. J Clin Neurosci 2017; 39:108-110. [PMID: 28209305 DOI: 10.1016/j.jocn.2017.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
Abstract
We describe the case of a 10-year-old boy who developed reversible cerebral vasoconstriction syndrome (RCVS) after cerebellitis. He received intravenous immunoglobulin and methylprednisolone to treat the cerebellitis. However, he then presented with a sudden severe headache, vomiting, and generalized tonic-clonic seizure. Brain magnetic resonance angiography (MRA) initially revealed diffuse cerebral vasodilatations, and diffuse multifocal segmental vasoconstrictions developed several days later. His clinical symptoms gradually resolved after several days, in the absence of any specific therapy. MRA performed 46days after symptom onset showed that the multifocal segmental vasoconstrictions had resolved, suggesting a diagnosis of RCVS. The imaging features of RCVS include multifocal segmental vasoconstriction. However, our case suggests that diffuse cerebral vasodilatation may in fact be evident during the early stage of disease.
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Affiliation(s)
- Yoshitsugu Oikawa
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yukimune Okubo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | | | - Yu Aihara
- Division of Pediatrics, Sendai City Hospital, Sendai, Japan
| | - Taro Kitamura
- Division of Pediatrics, Sendai City Hospital, Sendai, Japan
| | | | - Yukitoshi Takahashi
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Shizuoka, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
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Mrozek S, Lonjaret L, Jaffre A, Januel AC, Raposo N, Boetto S, Albucher JF, Fourcade O, Geeraerts T. Reversible Cerebral Vasoconstriction Syndrome with Intracranial Hypertension: Should Decompressive Craniectomy Be Considered? Case Rep Neurol 2017; 9:6-11. [PMID: 28203185 PMCID: PMC5301123 DOI: 10.1159/000455090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/13/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracerebral hemorrhage (ICH) causing intracranial hypertension. METHODS Case report. RESULTS We report a case of RCVS-related ICH leading to refractory intracranial hypertension. A decompressive craniectomy was performed to control intracranial pressure. We discuss here the management of RCVS with intracranial hypertension. Decompressive craniectomy was preformed to avoid the risky option of high cerebral perfusion pressure management with the risk of bleeding, hemorrhagic complications, and high doses of norepinephrine. Neurological outcome was good. CONCLUSION RCVS has a complex pathophysiology and can be very difficult to manage in cases of intracranial hypertension. Decompressive craniectomy should probably be considered.
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Affiliation(s)
- Ségolène Mrozek
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France
| | - Laurent Lonjaret
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France
| | - Aude Jaffre
- Department of Vascular Neurology, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France
| | - Anne-Christine Januel
- Department of Neuroradiology, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France
| | - Nicolas Raposo
- Department of Vascular Neurology, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France
| | - Sergio Boetto
- Department of Neurosurgery, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France
| | - Jean-François Albucher
- Department of Vascular Neurology, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France
| | - Olivier Fourcade
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France
| | - Thomas Geeraerts
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France
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Zhang J, Anil G. “Thunderclap” headache in a patient with depression: Answer. J Clin Neurosci 2017; 35:146. [DOI: 10.1016/j.jocn.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
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54
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[Reversible cerebral vasoconstriction syndrome: A rare pediatric cause of thunderclap headaches]. Arch Pediatr 2016; 23:1254-1259. [PMID: 27639512 DOI: 10.1016/j.arcped.2016.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/27/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches with diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. We report on a case of a 13-year-old boy presenting with acute severe headaches, triggered by physical exertion. His past medical history was uneventful. Moderate headache persisted between exacerbations for 4 weeks. He secondarily presented with signs of intracranial hypertension. Brain magnetic resonance angiography (MRA) revealed multifocal narrowing of the cerebral arteries. A glucocorticoid treatment was started based on the hypothesis of primary angiitis of the CNS. The symptoms rapidly improved, and repeat angiography at 3 months showed no vasoconstriction. Although pediatric cases are rare, RCVS should be considered in a child complaining of severe headache, especially after the use of vasoactive drugs or after Valsalva manoeuvres. RCVS is attributed to a transient, reversible dysregulation of cerebral vascular tone, which leads to multifocal arterial constriction and dilation. Physical examination, laboratory values, and initial cranial computed tomography are unremarkable, except when RCVS is associated with complications. Thunderclap headaches tend to resolve and then recur over a 1- to 4-week period, often with a milder baseline headache persisting between acute exacerbations. Angiography shows segmental narrowing and dilatation of one or more arteries, like a string of beads. Despite the absence of a proven treatment, important steps should be taken during the acute phase: removal of precipitants such as vasoactive substances, giving the patient rest, lowering blood pressure, and controlling seizures. Drugs targeted at vasospasms, such as calcium channel inhibitors, can be considered when cerebral vasoconstriction has been assessed. In most patients, the RCVS symptoms resolve spontaneously within days or weeks. Ischemic and hemorrhagic stroke are the major complications of the syndrome. A diagnosis of RCVS can only be confirmed when the reversibility of the vasoconstriction is assessed.
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55
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Topcuoglu MA, Singhal AB. Hemorrhagic Reversible Cerebral Vasoconstriction Syndrome. Stroke 2016; 47:1742-7. [DOI: 10.1161/strokeaha.116.013136] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/19/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mehmet A. Topcuoglu
- From the Massachusetts General Hospital, Harvard Medical School, Boston (M.A.T., A.B.S.); and Neurology Department, Hacettepe University Hospitals, Ankara, Turkey (M.A.T.)
| | - Aneesh B. Singhal
- From the Massachusetts General Hospital, Harvard Medical School, Boston (M.A.T., A.B.S.); and Neurology Department, Hacettepe University Hospitals, Ankara, Turkey (M.A.T.)
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56
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Lee DH, Lee SC, Choi N, Lee SW, Lee TK. Reversible Cerebral Vasoconstriction Syndrome Induced by Pseudoephedrine. JOURNAL OF NEUROCRITICAL CARE 2016. [DOI: 10.18700/jnc.2016.9.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Topcuoglu MA, McKee KE, Singhal AB. Gender and hormonal influences in reversible cerebral vasoconstriction syndrome. Eur Stroke J 2016; 1:199-204. [PMID: 31008280 DOI: 10.1177/2396987316656981] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/04/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction The reversible cerebral vasoconstriction syndromes, including postpartum angiopathy, have been characterized over the last decade. Women are predominantly affected. Some studies suggest that postpartum angiopathy carries a worse prognosis. Patients and methods We compared the clinical, neuroimaging, and angiographic features of 36 men, 110 non-pregnant women and 16 postpartum women included in our single-center cohort of patients with reversible cerebral vasoconstriction syndromes encountered from 1998 to 2016. Results As compared to men, non-pregnant women were older (48 ± 11 vs. 34 ± 13 years, p < 0.001), had more underlying migraine (49% vs. 19%, p = 0.002), depression (53% vs. 14%, p < 0.001) and serotonergic antidepressant use (45% vs. 11%, p < 0.001), developed more clinical worsening (18% vs. 3%, p = 0.022), more infarcts (39% vs. 20%, p = 0.031) and worse angiographic severity scores (23 ± 14 vs. 10.9 ± 10.3, p < 0.001), but had similar discharge outcomes (modified Rankin scale scores 0-3, 90% vs. 91%, p = 0.768). Sexual activity was an important trigger in men (22% vs. 4%, p = 0.002). As compared to non-pregnant women, postpartum angiopathy patients were younger (33 ± 6 years, p < 0.001) and had less vasoconstrictive drug exposure (25% vs. 67%, p = 0.002) but showed similar clinical, radiological and angiographic findings and similar discharge outcomes (modified Rankin scale scores 0-3 in 94%, p = 0.633). There were no significant differences between pre- and post-menopausal women, or those with and without hysterectomy. Discussion/Conclusion The observed gender differences in reversible cerebral vasoconstriction syndromes may result from hormonal or non-hormonal factors. Hormonal imbalances may trigger reversible cerebral vasoconstriction syndromes. Given the absence of significant differences in the female subgroups, hormonal factors do not appear to significantly affect the course or outcome of reversible cerebral vasoconstriction syndromes.
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Affiliation(s)
- Mehmet A Topcuoglu
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, USA.,Neurology Department, Hacettepe University Hospitals, Turkey
| | - Kathleen E McKee
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, USA
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58
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Santos L, Azevedo E. Reversible cerebral vasoconstriction syndrome - A narrative revision of the literature. Porto Biomed J 2016; 1:65-71. [PMID: 32258552 DOI: 10.1016/j.pbj.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/18/2015] [Indexed: 12/18/2022] Open
Abstract
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a not very well known clinical-imaging entity; it is characterized by thunderclap headache, which mimics an aneurysmal subarachnoid haemorrhage, and a diffuse and segmental constriction of cerebral arteries, that resolves spontaneously within 3 months. The pathophysiology remains unknown. The female gender is the more affected and more than half of cases occur in the puerperium or after exposure to vasoactive substances. Typically, RCVS is self-limited and has a benign course, although it may have more serious complications with permanent neurologic sequelae and death. Treatment is predominantly supportive and directed to the symptoms.
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Affiliation(s)
- Laura Santos
- Department of Neurology and Neurosurgery, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elsa Azevedo
- Department of Neurology and Neurosurgery, Faculty of Medicine of University of Porto, Porto, Portugal
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Shimoda M, Oda S, Hirayama A, Imai M, Komatsu F, Hoshikawa K, Shigematsu H, Nishiyama J, Osada T. Centripetal Propagation of Vasoconstriction at the Time of Headache Resolution in Patients with Reversible Cerebral Vasoconstriction Syndrome. AJNR Am J Neuroradiol 2016; 37:1594-8. [PMID: 27079368 DOI: 10.3174/ajnr.a4768] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache and diffuse segmental vasoconstriction that resolves spontaneously within 3 months. Previous reports have proposed that vasoconstriction first involves small distal arteries and then progresses toward major vessels at the time of thunderclap headache remission. The purpose of this study was to confirm centripetal propagation of vasoconstriction on MRA at the time of thunderclap headache remission compared with MRA at the time of reversible cerebral vasoconstriction syndrome onset. MATERIALS AND METHODS Of the 39 patients diagnosed with reversible cerebral vasoconstriction syndrome at our hospital during the study period, participants comprised the 16 patients who underwent MR imaging, including MRA, within 72 hours of reversible cerebral vasoconstriction syndrome onset (initial MRA) and within 48 hours of thunderclap headache remission. RESULTS In 14 of the 16 patients (87.5%), centripetal propagation of vasoconstriction occurred from the initial MRA to remission of thunderclap headache, with typical segmental vasoconstriction of major vessels. These mainly involved the M1 portion of the MCA (10 cases), P1 portion of the posterior cerebral artery (10 cases), and A1 portion of the anterior cerebral artery (5 cases). CONCLUSIONS This study found evidence of centripetal propagation of vasoconstriction on MRA obtained at the time of thunderclap headache remission, compared with MRA obtained at the time of reversible cerebral vasoconstriction syndrome onset. If clinicians remain unsure of the diagnosis during early-stage reversible cerebral vasoconstriction syndrome, this time point represents the best opportunity to diagnose reversible cerebral vasoconstriction syndrome with confidence.
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Affiliation(s)
- M Shimoda
- From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan
| | - S Oda
- From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan
| | - A Hirayama
- From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan
| | - M Imai
- From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan
| | - F Komatsu
- From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan
| | - K Hoshikawa
- From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan
| | - H Shigematsu
- Department of Neurosurgery (H.S., J.N., T.O.), Tokai University School of Medicine, Kanagawa, Japan
| | - J Nishiyama
- Department of Neurosurgery (H.S., J.N., T.O.), Tokai University School of Medicine, Kanagawa, Japan
| | - T Osada
- Department of Neurosurgery (H.S., J.N., T.O.), Tokai University School of Medicine, Kanagawa, Japan
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60
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Wolff V, Ducros A. Reversible Cerebral Vasoconstriction Syndrome Without Typical Thunderclap Headache. Headache 2016; 56:674-87. [DOI: 10.1111/head.12794] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Valérie Wolff
- Department of Neurology; Stroke Unit, Strasbourg University Hospital; Strasbourg France
- EA3072, Federation of Translational Medicine of Strasbourg, University of Strasbourg; Strasbourg France
| | - Anne Ducros
- Department of Neurology; Montpellier University Hospital; Montpellier France
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61
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Ducros A, Wolff V. The Typical Thunderclap Headache of Reversible Cerebral Vasoconstriction Syndrome and its Various Triggers. Headache 2016; 56:657-73. [DOI: 10.1111/head.12797] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Anne Ducros
- Department of Neurology; Montpellier University Hospital, and Montpellier University; Montpellier France (A. Ducros)
| | - Valérie Wolff
- Stroke Unit, Department of Neurology; Strasbourg University Hospital; Strasbourg France (V. Wolff)
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62
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Wolff V. Angiopatie cerebrali tossiche. Neurologia 2016. [DOI: 10.1016/s1634-7072(15)76143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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63
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Abstract
A 45-year-old woman with a history of depression and anxiety, treated with selective serotonin reuptake inhibitors (SSRIs), experienced acute, recurrent, and severe bifrontal headaches. Over time, she developed a left homonymous hemianopia and mental status changes. MRA revealed segmental vasoconstriction of cerebral arteries in multiple vascular distributions. She was treated with a calcium-channel blocker and magnesium, and there was resolution of her symptoms and cerebrovascular changes. Her clinical course and neuroimaging findings were consistent with reversible cerebral vasoconstriction syndrome. Although rare, this disorder frequently manifests with visual complaints. Although the prognosis is generally favorable, patients with this syndrome require prompt diagnosis and care directed to avoid complications including stroke, seizure, and subarachnoid hemorrhage.
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64
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Kim T, Ahn S, Sohn CH, Seo DW, Kim WY. Reversible cerebral vasoconstriction syndrome at the emergency department. Clin Exp Emerg Med 2015; 2:203-209. [PMID: 27752599 PMCID: PMC5052911 DOI: 10.15441/ceem.15.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 01/03/2023] Open
Abstract
Objective Reversible cerebral vasoconstriction syndrome (RCVS) is an underestimated cause of thunderclap headache that shares many characteristics with subarachnoid hemorrhage (SAH). This fact makes the two easily confused by emergency physicians. This study evaluated the clinical manifestations, radiological features, and outcomes of patients with RCVS. Methods The electronic medical records of 18 patients meeting the diagnostic criteria of RCVS at our emergency department between January 2013 and December 2014 were retrospectively reviewed. Results The mean patient age was 50.7 years, and 80% were women. Patients with RCVS encountered physicians 4.7 times before receiving an accurate diagnosis. The mean duration of symptoms until diagnosis was 9.3 days. All but one patient experienced severe headache of 8 to 10 on a numerical rating scale. A total of 44% of patients had nausea, and 66% of patients experienced worsening of the headache while gagging, leaning forward, defecating, urinating, or having sexual intercourse. The most frequently affected vessels were the middle cerebral arteries, which demonstrated a characteristic diffuse “string of beads” appearance. Four cases were complicated by SAH. Conclusion Patients with RCVS have a unique set of clinical and imaging features. Emergency physicians should have a high index of suspicion for this clinical entity to improve its rate of detection in patients with thunderclap headache when there is no evidence of aneurysmal SAH.
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Affiliation(s)
- Taerim Kim
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Shin Ahn
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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65
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Akazawa Y, Inaba Y, Hachiya A, Motoki N, Matsuzaki S, Minatoya K, Morisaki T, Morisaki H, Kosaki K, Kosho T, Koike K. Reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome in a boy with Loeys-Dietz syndrome. Am J Med Genet A 2015; 167A:2435-9. [DOI: 10.1002/ajmg.a.37202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/25/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Yohei Akazawa
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Yuji Inaba
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Akira Hachiya
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Noriko Motoki
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Satoshi Matsuzaki
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Kenji Minatoya
- Department of Vascular Surgery; National Cerebral and Cardiovascular Center; Suita Japan
| | - Takayuki Morisaki
- Department of Bioscience and Genetics; National Cerebral and Cardiovascular Center Research Institute; Suita Japan
| | - Hiroko Morisaki
- Department of Bioscience and Genetics; National Cerebral and Cardiovascular Center Research Institute; Suita Japan
| | - Kenjiro Kosaki
- Department of Pediatrics; Keio University School of Medicine; Tokyo Japan
| | - Tomoki Kosho
- Department Medical Genetics; Shinshu University School of Medicine; Matsumoto Japan
| | - Kenichi Koike
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
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66
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Calic Z, Cappelen-Smith C, Zagami AS. Reversible cerebral vasoconstriction syndrome. Intern Med J 2015; 45:599-608. [DOI: 10.1111/imj.12669] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 12/06/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Z. Calic
- Institute of Neurological Sciences; Prince of Wales Hospital; Sydney Australia
- Prince of Wales Clinical School; University of New South Wales; Sydney Australia
| | - C. Cappelen-Smith
- Department of Neurology and Neurophysiology; Liverpool Hospital; Sydney New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney Australia
| | - A. S. Zagami
- Institute of Neurological Sciences; Prince of Wales Hospital; Sydney Australia
- Prince of Wales Clinical School; University of New South Wales; Sydney Australia
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67
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Liang H, Xu Z, Zheng Z, Lou H, Yue W. Reversible cerebral vasoconstriction syndrome following red blood cells transfusion: a case series of 7 patients. Orphanet J Rare Dis 2015; 10:47. [PMID: 25896868 PMCID: PMC4418074 DOI: 10.1186/s13023-015-0268-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 04/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is an infrequent disease characterized by severe headaches with or without focal neurological deficits or seizures and a reversible vasoconstriction of cerebral arteries. The Orpha number for RCVS is ORPHA284388. However, RCVS triggered by blood transfusion is rare. Here we provided the clinical, neuroimaging and outcome data of patients diagnosed with RCVS resulting from red blood cells transfusion. METHODS We retrospectively identified 7 patients presenting with RCVS after red blood cells transfusion from January 2010 to May 2014. The information on clinical features, neuroimaging and outcome were collected and analyzed. RESULTS All 7 patients were Chinese women, with a mean age of 42 years (38-46). All the patients had severe anemia (Hb level < 6 g/dl) caused by primary menorrhagia due to uterine myoma (n = 5) or end-stage renal disease (n = 2) and severe anemia persisted for a average period of 4 months (2-6). Each patient received packed red blood cells transfusion (average: 1580 ml) over a period of 2-5 days. Blood transfusion increased the hemoglobin level by at least 4.5 g/dL from baseline. The neurological symptoms appeared a mean of 6.3 days (2-13) after the last blood transfusion. Headache was the most frequent symptom and seizure, transient or persistent neurological disorders were observed. Neuroimaging showed cortical subarachnoid hemorrhage (n = 2), focal intracerebral hemorrhage (n = 2), localized brain edema (n = 3), cerebral infarction (n = 1), and posterior reversible encephalopathy syndrome (n = 2). Cerebral vasoconstrictions were demonstrated by magnetic resonance angiography or cerebral angiography. Arterial constriction reversed in all patients within 1 to 3 months of follow-up after disease onset and no relapse was observed up to a mean of 17.1 ± 4.8 months of follow-up. CONCLUSIONS RCVS is a rare complication as a result of blood transfusion in patients with chronic severe anemia and should be considered in patients who show severe headache or neurologic deficits after transfusion.
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Affiliation(s)
- Hui Liang
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Ziqi Xu
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Zhijun Zheng
- Department of Neurology, Hengdian hospital of Zhejiang Province, Zhejiang, China.
| | - Haiyan Lou
- Department of Radiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, qixiangtai road 122, 300060, Tianjin, China.
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68
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Samanta D. Reversible cerebral vasoconstriction syndrome: another health hazard of energy drinks? Clin Pediatr (Phila) 2015; 54:186-7. [PMID: 25006115 DOI: 10.1177/0009922814541675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Debopam Samanta
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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69
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Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis. AJNR Am J Neuroradiol 2015; 36:1580-8. [PMID: 25614476 DOI: 10.3174/ajnr.a4215] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The diagnostic evaluation of a patient with reversible cerebral vasoconstriction syndrome integrates clinical, laboratory, and radiologic findings. Imaging plays an important role by confirming the presence of cerebral vasoconstriction; monitoring potential complications such as ischemic stroke; and suggesting alternative diagnoses, including CNS vasculitis and aneurysmal subarachnoid hemorrhage. Noninvasive vascular imaging, including transcranial Doppler sonography and MR angiography, has played an increasingly important role in this regard, though conventional angiography remains the criterion standard for the evaluation of cerebral artery vasoconstriction. Newer imaging techniques, including high-resolution vessel wall imaging, may help in the future to better discriminate reversible cerebral vasoconstriction syndrome from primary angiitis of the CNS, an important clinical distinction.
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Affiliation(s)
- T R Miller
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - R Shivashankar
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - M Mossa-Basha
- Department of Diagnostic Radiology (M.M.-B.), Section of Neuroradiology, University of Washington, Seattle, Washington
| | - D Gandhi
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
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Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course. AJNR Am J Neuroradiol 2015; 36:1392-9. [PMID: 25593203 DOI: 10.3174/ajnr.a4214] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Reversible cerebral vasoconstriction syndrome is a clinical and radiologic syndrome that represents a common presentation of a diverse group of disorders. The syndrome is characterized by thunderclap headache and reversible vasoconstriction of cerebral arteries, which can either be spontaneous or related to an exogenous trigger. The pathophysiology of reversible cerebral vasoconstriction syndrome is unknown, though alterations in cerebral vascular tone are thought to be a key underlying mechanism. The syndrome typically follows a benign course; however, reversible cerebral vasoconstriction syndrome may result in permanent disability or death in a small minority of patients secondary to complications such as ischemic stroke or intracranial hemorrhage.
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Affiliation(s)
- T R Miller
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - R Shivashankar
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - M Mossa-Basha
- Department of Diagnostic Radiology (M.M.-B.), Section of Neuroradiology, University of Washington, Seattle, Washington
| | - D Gandhi
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
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Ekusheva EV, Damulin IV. [Current approaches to treatment of migraine during pregnancy]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:124-132. [PMID: 27030834 DOI: 10.17116/jnevro2015115111124-132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Migraine is one of the most common complaints in the majority of pregnant women. Migraine without aura is the most frequent cause of headache. Improvement of this disease is reported in 50-80% of patient. However, about one third of pregnant women have severe prolonged attacks with marked concomitant symptoms and maladaptation that necessarily need treatment. Authors consider the issues of differential diagnosis and principles of management of these patients.
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Affiliation(s)
- E V Ekusheva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - I V Damulin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Wolff V, Armspach JP, Lauer V, Rouyer O, Ducros A, Marescaux C, Gény B. Ischaemic strokes with reversible vasoconstriction and without thunderclap headache: a variant of the reversible cerebral vasoconstriction syndrome? Cerebrovasc Dis 2014; 39:31-8. [PMID: 25547150 DOI: 10.1159/000369776] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Reversible vasoconstriction (RV) may cause ischaemic stroke (IS) in the absence of any other defined stroke aetiology. The three objectives of our study were to evaluate the frequency of RV in a prospective series of young IS patients, to describe the detailed clinical-radiological features in the patients with RV and IS, and to compare these characteristics with those of reversible cerebral vasoconstriction syndrome (RCVS). METHODS We identified between October 2005 and December 2010, 159 consecutive young patients (<45 years) hospitalized for an acute IS confirmed by cerebral magnetic resonance imaging. An extensive diagnostic work-up was performed including toxicological urinary screening for cannabis, cocaine and amphetamines, and the usual biological, cardiac and vascular investigations for an IS in the young. We specifically studied patients with IS and RV, which was defined as multifocal intracranial arterial stenoses confirmed by intracranial arterial imaging that resolved within 3-6 months. RESULTS Out of 159 patients with IS, 21 (13%, 12 males, 9 females; mean age 32 years) had multifocal cerebral arterial stenoses that were fully reversible at 3-6 months, and no other cause for stroke. IS were located on posterior territory in 71% of cases, and vasoconstriction predominated on posterior cerebral and superior cerebellar arteries. Precipitating factors of IS and RV were the use of cannabis resin (n = 14), nasal decongestants (n = 2) and triptan (n = 1). Most cases (74%) had unusual severe headache, but none had thunderclap headache. None of 21 cases had reversible posterior leukoencephalopathy, cortical subarachnoid or intracerebral haemorrhage. CONCLUSION RV was the sole identified cause of IS in 13% of our cohort. These young patients with IS and RV may have a variant of RCVS, related to an increased susceptibility to vasoactive agents in some individuals. RV in our patients differs from the classical characteristics of RCVS by the absence of thunderclap headache, reversible brain oedema and subarachnoid or intracranial haemorrhage. Intracranial arteries should be looked for, by appropriate vascular imaging, in young patients with IS at the acute stage and during the follow-up period.
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Affiliation(s)
- Valérie Wolff
- Unité Neuro-Vasculaire, Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Sheikh HU, Mathew PG. Reversible cerebral vasoconstriction syndrome: updates and new perspectives. Curr Pain Headache Rep 2014; 18:414. [PMID: 24658747 DOI: 10.1007/s11916-014-0414-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is an important cause of headaches that can lead to other neurological complications, including stroke, if not recognized early. Over the past few years, there has been great progress in the recognition of this entity. However, there is still much to be learned about its pathophysiology and optimal treatment strategies. RCVS occurs mostly in middle-aged adults, and there is a female preponderance with an increased incidence during the postpartum period. A consistent, predominating feature is a sudden-onset, severe headache that is frequently recurrent, usually over the span of a week. Less common presentations include seizures or focal neurological symptoms. Important causative factors include vasoactive medications, as well as illicit drugs like marijuana and cocaine. The current underlying pathophysiology is thought to be a disturbance in cerebrovascular tone leading to vasoconstriction. The diagnosis is based on history, physical examination, and cerebrovascular imaging findings that demonstrate multifocal, segmental areas of vasoconstriction in large- and medium-sized arteries. An important criterion for making the diagnosis is the eventual reversibility of symptoms and imaging findings.
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Affiliation(s)
- Huma U Sheikh
- Brigham and Women's Hospital, Department of Neurology, John R. Graham Headache Center, Harvard Medical School, 1153 Centre Street, Suite 4970, Boston, MA, 02130, USA,
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Abstract
Etoricoxib is a newer cyclooxygenase (COX)-2 inhibitor anti-inflammatory drug with a favorable safety profile. However, several randomized trials have provided evidence of an increased risk for acute myocardial infarction associated with the use of COX-2 inhibitors. Fewer data are available concerning the risk for ischemic stroke associated with COX-2 inhibitors. Although sporadic classes of drug-induced reversible cerebral vasoconstriction syndrome (RCVS) have been reported, this was not the case for etoricoxib. We report a patient who developed thunderclap headache, reversible cerebral arterial vasoconstriction, high blood pressure, and ischemic stroke (ie, RCVS) with recent exposure to etoricoxib. Although the association is hypothetical, the authors suggest consideration of RCVS in hypertensive patients presenting with headache, focal deficits, and evidence of cerebral ischemia during COX-2 inhibitors use.
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Canaple S, Fournier A, Bugnicourt JM, Deramond H, Lamy C, Godefroy O. Syndrome de vasoconstriction cérébrale réversible et cardiomyopathie de Tako-Tsubo : une association fortuite ? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.praneu.2014.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Agarwal R, Davis C, Altinok D, Serajee FJ. Posterior reversible encephalopathy and cerebral vasoconstriction in a patient with hemolytic uremic syndrome. Pediatr Neurol 2014; 50:518-21. [PMID: 24731845 DOI: 10.1016/j.pediatrneurol.2014.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/17/2013] [Accepted: 01/05/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND We report a patient with hemolytic uremic syndrome who presented with radiological manifestations suggestive of posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome. PATIENT A 13-year-old girl presented with fever and bloody diarrhea and progressed to develop hemolytic uremic syndrome. She subsequently developed encephalopathy, aphasia, and right-sided weakness. RESULTS Brain magnetic resonance imaging showed presence of vasogenic edema in the left frontal lobe, in addition to T2 and fluid-attenuated inversion recovery changes in white matter bilaterally, compatible with posterior reversible encephalopathy syndrome. Magnetic resonance angiography showed beading of the cerebral vessels. Neurological deficits reversed 8 days after symptom onset, with resolution of the beading pattern on follow-up magnetic resonance angiography after 3 weeks, suggesting reversible cerebral vasoconstriction syndrome. CONCLUSIONS Both posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome may represent manifestations of similar underlying pathophysiologic mechanisms. Recognition of the co-existence of these processes in patients with hemolytic uremic syndrome may aid in judicious management of these patients and avoidance of inappropriate therapeutic interventions.
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Affiliation(s)
- Rajkumar Agarwal
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.
| | - Cresha Davis
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Deniz Altinok
- Department of Radiology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Fatema J Serajee
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
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Dou YH, Fuh JL, Chen SP, Wang SJ. Reversible cerebral vasoconstriction syndrome after blood transfusion. Headache 2014; 54:736-44. [PMID: 24628283 DOI: 10.1111/head.12319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To report 2 cases of reversible cerebral vasoconstriction syndrome (RCVS) with posterior reversible encephalopathy syndrome (PRES) after blood transfusion for severe anemia. BACKGROUND RCVS is presented with recurrent thunderclap headache and reversible constriction of cerebral arteries. PRES is a known complication of RCVS. Blood transfusion for severe anemia could be a cause for PRES in few cases; however, it is seldom mentioned as an etiology for RCVS. METHODS We report a case series. RESULTS We report 2 women presented with RCVS with PRES after blood transfusion for anemia, and reviewed another 4 similar cases reported in the literature. Our 2 patients were middle-aged women, with severe chronic anemia (average hemoglobin: 1.45 g/dL), and received multiple blood transfusions (average: 3250 mL) over a period of 5-7 days. They developed thunderclap headache and other symptoms about 1 week after the last blood transfusion. Cerebral vasoconstrictions were demonstrated by magnetic resonance angiography and transcranial color-coded sonography. PRES was found in both of them using magnetic resonance imaging, and one of them also had cytotoxic edema on diffusion weighted image. CONCLUSIONS RCVS with PRES is one complication of blood transfusion in patients under chronic severe anemia (especially when hemoglobin level increased for more than 5 g/dL), particularly in Asian women with menorrhagia. Blood pressure surge and the occurrence of severe headaches or other neurological symptoms should be aggressively monitored within 10 days after the last blood transfusion.
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Affiliation(s)
- Yi-Hsuan Dou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Uenaka T, Hamaguchi H, Sekiguchi K, Kowa H, Kanda F, Toda T. [Reversible cerebral vasoconstriction syndrome in a stroke patient with systemic lupus erythematosus and antiphospholipid antibody]. Rinsho Shinkeigaku 2014; 53:283-6. [PMID: 23603542 DOI: 10.5692/clinicalneurol.53.283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 36-year-old female with systemic lupus erythematosus and antiphospholipid syndrome was referred to our department because of mild weakness of left arm and an episode of right amaurosis fugax for twenty days. Brain MRI showed right ACA/MCA/PCA border zone infarction on DWI/T2WI/FLAIR and MR angiography (MRA) showed multiple segmental stenosis in right internal carotid artery, right and left middle cerebral artery, and bilateral posterior cerebral arteries. Treatment with oral aspirin (100 mg/day) and continuous infusion of heparin kept her neurological symptoms and signs stable. MRA on 28 days revealed complete recovery of multiple stenotic lesions, thus, diagnosis of reversible cerebral vasoconstriction (RCVS) was made. RCVS should be considered as a cause of neurological deficit in patients with SLE regardless of thunderclap headache.
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Affiliation(s)
- Takeshi Uenaka
- Division of Neurology, Kobe University Graduate School of Medicine
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Dramatic intracerebral hemorrhagic presentations of reversible cerebral vasoconstriction syndrome: three cases and a literature review. Case Rep Neurol Med 2014; 2014:782028. [PMID: 24707417 PMCID: PMC3965932 DOI: 10.1155/2014/782028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/10/2013] [Indexed: 12/17/2022] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) refers to a number of disorders characterized by severe and sudden-onset (“thunderclap”) headaches and angiographic features of reversible, segmental, multifocal vasoconstriction of cerebral arteries. Although RCVS generally resolves without significant sequelae, a rare and possibly underrecognized hemorrhagic presentation has a worse potential course. We report three cases of hemorrhagic RCVS and review the literature. Three females (42, 54, and 33 years old, resp.) presented with severe headache, neurological deficits, and dramatic intracerebral hemorrhage (ICH). Patient 1 presented comatose with a 9 × 4 × 6.6 cm left deep intraparenchymal hemorrhage (IPH) and 1 cm midline shift. She underwent emergent surgical intervention. Patient 2 had a 3.3 × 1.5 cm left superior frontal IPH that enlarged to 4 × 2.5 cm within 12 hours with worsening headache and neurological deficits. She was successfully managed nonoperatively. Patient 3, after uncomplicated pregnancy and delivery, presented with a 1.5 cm left superior parietal IPH on postpartum day 7. Two days later, she acutely developed right hemiplegia. Repeat CT demonstrated a new 3.3 × 1.7 cm left frontal IPH. She was also successfully managed nonoperatively. Many diverse conditions are grouped within the category of RCVS. Dramatic ICH remains a rare and possibly underrecognized presenting feature. Prompt diagnosis and management are essential for obtaining the best outcome.
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Kaneko C, Shakespear N, Tsuchiya M, Kubo J, Yamamoto T, Katayama S. Reversible cerebral vasoconstriction syndrome (RCVS) of peripartum successfully treated with magnesium sulfate. ACTA ACUST UNITED AC 2014. [DOI: 10.3995/jstroke.36.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reversible cerebral vasoconstriction syndrome (RCVS) in antiphospholipid antibody syndrome (APLA): the role of centrally acting vasodilators. Case series and review of literature. Clin Rheumatol 2013; 33:1829-33. [PMID: 24277114 DOI: 10.1007/s10067-013-2434-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 11/01/2013] [Indexed: 10/26/2022]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is Raynaud's phenomenon of the brain. Changes in neurological function are dependent upon which areas of the brain are deprived of normal blood flow. Antiphospholipid antibody syndrome (APLA) is a common cause of Raynaud's phenomenon that can occur anywhere in the body, including the brain. Management of CNS vasospasm generally involves the use of centrally acting calcium channel blockers, which have been shown to relieve the associated headaches and transient neurological symptoms associated with it. Three patients with APLA and RCVS from our clinics are illustrated. It is demonstrated that the use of centrally acting calcium channel-blocking drugs, such as nimodipine, which prevent and reverse CNS vasospasm, led to clinical improvement in our patients over the course of 5-9 years. All of them had MRIs done at the initiation of therapy and 5-9 years after being on therapy. MRI measures of T2 lesion volumes (LVs) and number were obtained. All three patients had a good response in controlling clinical symptoms related to CNS vasospasm, Raynaud's phenomenon, visual disturbances, confusion, headaches, and hearing loss. There was also a resolution in the MRI findings of these patients. This case series of three patients shows a clinical improvement and decrease in T2 LV and number in patients with APLA and Raynaud's syndrome on centrally acting calcium channel blockers. RCVS is much more common than that currently appreciated. APLA is the common cause of RCVS. Further studies are needed to determine the optimal methods to diagnose RCVS and optimal therapies to treat it.
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Chen SP, Yang AC, Fuh JL, Wang SJ. Autonomic dysfunction in reversible cerebral vasoconstriction syndromes. J Headache Pain 2013; 14:94. [PMID: 24274860 PMCID: PMC4177393 DOI: 10.1186/1129-2377-14-94] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/19/2013] [Indexed: 12/22/2022] Open
Abstract
Background Autonomic imbalance may play an important role in the pathogenesis of reversible cerebral vasoconstriction syndromes (RCVS). This study aimed to assess the autonomic function by analyzing heart rate variability (HRV) in patients with RCVS. Methods Patients with RCVS and age- and gender-matched controls were consecutively recruited. All patients (both ictal and remission stage) and controls underwent 24-hour ambulatory electrocardiographic (ECG) recordings. HRV measures covering time and frequency domains were used to assess autonomic functioning. Results Thirty-nine patients with RCVS and 39 controls completed the study. Compared to the controls, RCVS patients during the ictal stage showed reductions in parasympathetic-related indices, including the root mean square of difference of consecutive interbeat intervals (RMSSD) (22.1 ± 7.0 vs. 35.2 ± 14.2, p < 0.001), the percentage of adjacent intervals that varied by more than 50 ms (pNN50) (3.7 ± 3.4 vs. 10.6 ± 8.1, p < 0.001), and high-frequency power (HF) (5.82 ± 0.73 vs. 6.77 ± 0.74; p < 0.001), and increased low-frequency/high-frequency (LF/HF) ratio (index of sympathovagal balance) (3.38 ± 1.32 vs. 2.48 ± 1.07; p =0.001). These HRV indices improved partially but remained significantly different from controls during remission. Conclusions Decreased parasympathetic modulations and accentuated sympathetic activity might be a biological trait in patients with RCVS.
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Affiliation(s)
- Shih-Pin Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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Yancy H, Lee-Iannotti JK, Schwedt TJ, Dodick DW. Reversible cerebral vasoconstriction syndrome. Headache 2013; 53:570-6. [PMID: 23489219 DOI: 10.1111/head.12040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 11/29/2022]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular disorder with a clinical picture that continues to be refined. It has presented to multiple subspecialties over the past several decades, bringing with it many questions regarding risk factors, diagnosis, and management. Answers have been forthcoming but many questions remain. RCVS presents with recurrent, secondary thunderclap headaches and predominantly affects young women. The mechanism of vasoconstriction is unclear, but there has been speculation regarding a hyperadrenergic state. Diagnosis requires physician awareness, vascular imaging, and knowledge of the differential. The hallmark of its diagnosis is reversibility. Management is empiric, usually with calcium-channel blockers, as there are no controlled treatment trials for RCVS. Randomized controlled trials are needed.
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Affiliation(s)
- Holly Yancy
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
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Wöpking S, Kastrup A, Lentschig M, Brunner F. Recurrent Strokes due to Transient Vasospasms of the Extracranial Internal Carotid Artery. Case Rep Neurol 2013; 5:143-8. [PMID: 24052791 PMCID: PMC3776468 DOI: 10.1159/000354827] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Vasospasms of the intracranial arteries are a well-known complication of subarachnoid hemorrhage and are also frequently encountered in other disorders such as migraine, cerebral vasculitis or reversible cerebral vasoconstriction syndrome. In contrast, recurrent spontaneous vasospasms of the extracranial circulation appear to be extremely rare and have most often been associated with migraine. We present a patient with recurrent strokes due to spontaneous transient vasospastic occlusions of the internal carotid artery (ICA) without migraine over a time period of at least 13 years. Initially, the patient had presented with a bilateral ICA occlusion and a cerebral infarct on the right side. While the right ICA remained occluded, a reopening of the left ICA could be detected 3 days after this initial event. In subsequent years, both duplex sonography and magnetic resonance angiography revealed recurrent occlusions of the left ICA, which resolved spontaneously within days. This case and other rare previous reports indicate that recurrent non-migrainous vasospasms of the extracranial carotid artery likely reflect a distinct entity which can cause ischemic strokes.
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Affiliation(s)
- Sigrid Wöpking
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
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Bain J, Segal D, Amin R, Monoky D, Thompson SJ. Call-Fleming syndrome: headache in a 16-year-old girl. Pediatr Neurol 2013; 49:130-133.e1. [PMID: 23859861 DOI: 10.1016/j.pediatrneurol.2013.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 05/07/2013] [Accepted: 05/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Call-Fleming syndrome, also known as reversible cerebral vasoconstriction syndrome, is an important cause of severe headache characterized by segmental constriction of cerebral arteries in multiple vascular distributions. It is commonly described in adults, with a female predominance. PATIENT We report a case of a 16-year-old girl with history of anxiety, attention deficit hyperactivity disorder, and migraines on several medications presenting with 2 weeks of worsening headaches. RESULTS Cranial computed tomography was normal, but magnetic resonance imaging revealed cortical subarachnoid hemorrhage. Follow-up imaging demonstrated extensive vasoconstriction of small- to medium-sized cerebral arteries. Sertraline and methylphenidate were discontinued, and nifedipine was started. Symptoms rapidly improved, and repeat angiography at 2 months showed no vasoconstriction. CONCLUSIONS Call-Fleming syndrome is an important cause of thunderclap headache and should be considered in the pediatric population, especially in the setting of certain medication usage and other known risk factors.
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Affiliation(s)
- Jennifer Bain
- University of Medicine and Dentistry of New Jersey - New Jersey Medical School, Newark, New Jersey, USA.
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Velez A, McKinney JS. Reversible cerebral vasoconstriction syndrome: a review of recent research. Curr Neurol Neurosci Rep 2013; 13:319. [PMID: 23250764 DOI: 10.1007/s11910-012-0319-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a collective term used for transient noninflammatory, nonatherosclerotic segmental constriction of cerebral arteries. The angiopathies of RCVS have previously been defined by several nomenclatures. Current opinion favors the unification of these pathophysiologically related angiopathies because of their similar angiographic features and clinical course. RCVS typically presents acutely as headache, delirium, seizure, cerebral ischemia, and/or hemorrhage. The angiographic features make RCVS an important mimic of CNS vasculitides. In contrast to CNS vasculitis, RCVS is typically a transient condition with relatively good clinical outcomes. Although a complete understanding of the etiological and pathological features of RCVS has not yet been achieved, alterations in vascular tone lead to the observed arterial changes. In this review, we aim to provide a summary of RCVS and provide insight into current perspectives of the underlying pathophysiological processes, diagnosis, and treatment.
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Affiliation(s)
- Arnaldo Velez
- Department of Neurology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA.
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Thunderclap headache as the main symptom of an acute aortic dissection type A. J Neurol 2013; 260:1925-6. [PMID: 23712801 DOI: 10.1007/s00415-013-6969-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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Probert R, Saunders DE, Ganesan V. Reversible cerebral vasoconstriction syndrome: rare or underrecognized in children? Dev Med Child Neurol 2013; 55:385-9. [PMID: 23066702 DOI: 10.1111/j.1469-8749.2012.04433.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a clinicoradiological diagnosis comprising 'thunderclap' headaches and reversible segmental vasoconstriction of cerebral arteries, occasionally complicated by ischaemic or haemorrhagic stroke. We report a case of RCVS in a 13-year-old male with severe thunderclap headaches and no focal neurological signs. Brain imaging showed multiple posterior circulation infarcts; cerebral computed tomography, magnetic resonance imaging, and catheter angiography showed multifocal irregularity and narrowing, but in different arterial segments. Laboratory studies did not support a diagnosis of vasculitis. Symptoms resolved over 3 weeks; magnetic resonance angiography 3 months later was normal and remained so after 2 years. We highlight the typical clinical features of RCVS in this case and suggest that the diagnosis should be considered in children with thunderclap headaches or stroke syndromes where headache is a prominent feature, especially if cerebrovascular imaging studies appear to be evolving or discrepant.
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Affiliation(s)
- Rebecca Probert
- Neurosciences Unit, University College London Institute of Child Health, London, UK.
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91
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Bayer-Karpinska A, Patzig M, Adamczyk C, Dimitriadis K, Wollenweber FA, Dichgans M, Jahn K, Opherk C. Reversible cerebral vasoconstriction syndrome with concurrent bilateral carotid artery dissection. Cephalalgia 2013; 33:491-5. [DOI: 10.1177/0333102413479836] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The pathophysiological basis of reversible cerebral vasoconstriction syndrome is poorly understood but carotid artery dissection has been discussed as a rare possible cause. So far, only single cases of unilateral carotid artery dissection and reversible cerebral vasoconstriction syndrome have been reported. Case Here, we describe the case of a 54-year old patient presenting to the emergency department with right hemiparesis, hypaesthesia and dysarthria. Furthermore, he reported two episodes of thunderclap headache after autosexual activity. Cerebral imaging showed ischaemic infarcts, slight cortical subarachnoid haemorrhage, bilateral carotid artery dissection and fluctuating intracranial vessel irregularities, compatible with reversible cerebral vasoconstriction syndrome. An extensive diagnostic work-up was normal. No typical trigger factors of reversible cerebral vasoconstriction syndrome could be found. The patient received intravenous heparin and the calcium channel blocker nimodipine. Follow-up imaging revealed no vessel irregularities, the left internal carotid artery was still occluded. Conclusion This case supports the assumption that carotid artery dissection should be considered as a potential trigger of reversible cerebral vasoconstriction syndrome, possibly by altering sympathetic vascular tone.
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Affiliation(s)
- Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, Ludwig-Maximilians- University, Munich, Germany
| | - Maximilian Patzig
- Department of Neuroradiology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Ludwig-Maximilians- University, Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians- University, Munich, Germany
| | - Klaus Jahn
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Opherk
- Institute for Stroke and Dementia Research, Ludwig-Maximilians- University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
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Hijikata Y, Watanabe H, Ito M, Yoneyama N, Atsuta N, Sobue G. [Reversible cerebral vasoconstriction syndrome (RCVS) triggered by nicotine patches]. Rinsho Shinkeigaku 2013; 53:721-723. [PMID: 24097321 DOI: 10.5692/clinicalneurol.53.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present a case of a patient with reversible cerebral vasoconstriction syndrome (RCVS) triggered by nicotine patches. A-50-year-old woman had no medical history and no regular medication. She smoked 20 cigarettes a day for 30 years. Six days after using nicotine patches, she had recurrent severe headaches of sudden onset (thunderclap headaches). On examination, the blood pressure was 142/88 mmHg. Her neurological and general examination, laboratory serum investigations, and cerebrospinal fluid examination were normal. Magnetic resonance imaging (MRI) including magnetic resonance angiography (MRA) on admission, day 10 after the first episode showed severe multifocal segmental narrowing of the bilateral posterior cerebral artery (PCA). Cessation of nicotine patches and administration of calcium-channel antagonist amlodipine 5 mg daily ameliorated her headache. Follow-up MRA, 37 days after the first episode, showed improvement of PCA stenosis. We diagnosed her as reversible cerebral vasoconstriction syndrome (RCVS) due to nicotine patches. It is important to recognize nicotine patches as a trigger of RCVS.
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Affiliation(s)
- Yasuhiro Hijikata
- Department of Neurology, Nagoya University Graduate School of Medicine
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93
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McGeeney BE. Cannabinoids and Hallucinogens for Headache. Headache 2012; 53:447-58. [DOI: 10.1111/head.12025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/26/2022]
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