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Liu L, Tan Q, Huang R, Hu Z. Analysis of postpartum reversible cerebral vasoconstriction syndrome in China: A case report and literature review. Medicine (Baltimore) 2019; 98:e17170. [PMID: 31702607 PMCID: PMC6855623 DOI: 10.1097/md.0000000000017170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare clinical syndrome accompanying with severe headache as its main symptom. Postpartum reversible cerebral vasoconstriction syndrome (PPRCVS) refers to RCVS occurring in the puerperium, in which it has a low incidence, and that is easily missed diagnosed and misdiagnosed in clinical practice.By searching in CNKI and Wanfang databases, 9 published articles reported PPRCVS were found, totally including 12 cases with PPRCVS. The clinical data of these 12 cases were accordingly analyzed and summarized. The characteristics of these cases were compared with those reported in other countries, and eventually the clinical characteristics of Chinese PPRCVS patients were summarized.The clinical characteristics of Chinese PPRCVS patients were basically as same as those found in other countries, while the onset age was earlier, PPRCVS often occurred earlier after delivery, with higher proportions of concomitant symptoms and abnormal laboratory and imaging examinations; moreover, and fewer patients were diagnosed by digital subtraction angiography (DSA).
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Affiliation(s)
- Lin Liu
- Neurology Department, Tungwah Hospital of Sun Yat-sen University, Dongguan
| | - Qi Tan
- Neurology Department, Tungwah Hospital of Sun Yat-sen University, Dongguan
| | - Ruxun Huang
- Neurology Department, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zongji Hu
- Neurology Department, Tungwah Hospital of Sun Yat-sen University, Dongguan
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2
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Skeik N, Porten BR, Kadkhodayan Y, McDonald W, Lahham F. Postpartum reversible cerebral vasoconstriction syndrome: Review and analysis of the current data. Vasc Med 2015; 20:256-65. [DOI: 10.1177/1358863x14567976] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postpartum reversible cerebral vasoconstriction syndrome (PPRCVS) is a rare but serious cause of headache that occurs in the early postpartum period. The rarity of this disorder has limited the current literature to single case reports and small, observational case series. The lack of familiarity with PPRCVS may contribute to mismanagement of these unique patients and lead to poor outcomes. To address current gaps in the understanding of PPRCVS, this review and data analysis characterizes the demographics, presentation, clinical course, management and prognosis of PPRCVS and provides a general review of the epidemiology, pathophysiology and diagnosis to assist clinicians who may care for patients with this rare disorder.
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Affiliation(s)
- Nedaa Skeik
- Vascular Medicine, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Yasha Kadkhodayan
- Department of Pathology, Interventional Neuroradiology, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Firas Lahham
- Internal Medicine, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Mathon B, Ducros A, Bresson D, Herbrecht A, Mirone G, Houdart E, Saint-Maurice JP, Di Emidio P, George B, Chibbaro S. Subarachnoid and intra-cerebral hemorrhage in young adults: rare and underdiagnosed. Rev Neurol (Paris) 2014; 170:110-8. [PMID: 24411684 DOI: 10.1016/j.neurol.2013.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/03/2013] [Accepted: 07/19/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Convexity subarachnoid and intra-cerebral hemorrhages, in patients aged<50 years, are always a diagnostic challenge. This condition is characterized by acute headaches with or without neurological symptoms and/or seizures, and by the radiological demonstration of subarachnoid and/or intra-cerebral hemorrhages and, more rarely, by the association of ischemic events. PATIENTS AND METHODS In a prospective series of 30 consecutive patients (median age 31 years; 22 women) with a subarachnoid and intra-cerebral hemorrhages, 19 were diagnosed with reversible cerebral vasoconstriction syndrome (RCVS), 7 with cerebral venous sinus thrombosis (CVST), and 4 with a bleeding mycotic aneurysm (MA). RESULTS RCVS appeared spontaneously in 16 patients and was related to the postpartum period in three cases. Subarachnoid hemorrhage (SAH) was demonstrated in 24 patients as follows: 18 cases were in cortical areas, 4 were in the polygon of Willis, one was inter-hemispheric, and one was inter-hemispheric/intra-cerebral. A convexity pure intra-cerebral hemorrhage (ICH) was recorded in 6 cases. Among the 7 patients suffering from CVST, the superior sagittal sinus was involved in 4 cases, the transverse sinuses (TS) in 2, and the TS plus sigmoid sinus (SS) in one. CONCLUSION The three most common causes in this series were RCVS, followed by CVST and bleeding from MA. Because of atypical clinical or radiological presentations, this large spectrum of etiologies can cause diagnostic difficulties. Therefore, careful analysis is needed to ensure correct and prompt diagnosis and to avoid any dangerous delays in management.
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Affiliation(s)
- B Mathon
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
| | - A Ducros
- Service de neurologie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - D Bresson
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A Herbrecht
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - G Mirone
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - E Houdart
- Service de neuroradiologie interventionnelle, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - J-P Saint-Maurice
- Service de neuroradiologie interventionnelle, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - P Di Emidio
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - B George
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - S Chibbaro
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
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Hannah JB, Kissel P, Russell B, Hose JE. Dystextia: An Early Sign of Pregnancy-Associated Meningioma. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojmn.2014.42015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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5
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Call-fleming syndrome (reversible cerebral artery vasoconstriction) and aneurysm associated with multiple recreational drug use. Case Rep Neurol Med 2013; 2013:729162. [PMID: 23476840 PMCID: PMC3582080 DOI: 10.1155/2013/729162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 01/15/2013] [Indexed: 11/17/2022] Open
Abstract
Drug abuse represents a significant health issue. Evidence suggests that recreational drug use has a direct effect on the cerebral vasculature and is of greater concern in those with undiagnosed aneurysms or vascular malformations. The authors report a case of thunderclap headache with a negative head CT and equivocal lumbar puncture after a drug-fueled weekend. The patient underwent diagnostic cerebral angiogram which demonstrated multisegmental, distal areas of focal narrowing of the middle, anterior, posterior, and posterior inferior cerebral artery and an incidental aneurysm. It is often difficult to determine the exact origin of symptoms; thus we were left with a bit of a chicken or the egg debate, trying to decipher which part came first. Either the aneurysm ruptured with associated concomitant vasospasm or it is a case of Call-Fleming syndrome (reversible cerebral artery vasoconstriction) with an incidental aneurysm. The authors proposed their management and rationale of this complex case.
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Ba F, Giuliani F, Camicioli R, Saqqur M. A reversible cerebral vasoconstriction syndrome. BMJ Case Rep 2012; 2012:bcr.09.2011.4841. [PMID: 22787186 DOI: 10.1136/bcr.09.2011.4841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is typically presented with severe headaches where, vascular imaging demonstrates multiple intracranial arterial narrowing. Variable triggers are related to RCVS, such as serotonin agents and bromocriptine. Thus, a detailed medication history is important. Subarachnoid haemorrhage (SAH) is not uncommon in RCVS. Repeat vascular imaging at 2-3 months with complete reversal of the narrowed vessels confirms the diagnosis of RCVS. The authors present a case where use of triptan along with multiple psychotropic medications, was associated with RVCS. Neuroimaging demonstrated focal SAH and diffuse beaded appearance involving the intracranial vasculature. The patient improved clinically with oral nimodipine treatment. Repeat angiography and a follow-up transcranial Doppler showed complete resolution of vasoconstriction. In the setting of acute severe headache, with any 'red flags', it is important to evaluate the medication use and other precipitating risks for RVCS. Vascular imaging is the key for diagnosis.
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Affiliation(s)
- Fang Ba
- Division of Neurology, University of Alberta, Edmonton, Canada
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Lee SY, Sheen SH, Lee SH, Kim SS, Kim CH, Yie KS, Kim SH. Postpartum cerebral angiopathy presenting with non-aneurysmal subarachnoid hemorrhage. J Clin Neurosci 2011; 18:1269-71. [DOI: 10.1016/j.jocn.2011.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/10/2011] [Accepted: 01/16/2011] [Indexed: 10/18/2022]
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Sattar A, Manousakis G, Jensen MB. Systematic review of reversible cerebral vasoconstriction syndrome. Expert Rev Cardiovasc Ther 2011; 8:1417-21. [PMID: 20936928 DOI: 10.1586/erc.10.124] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular disorder associated with multifocal arterial constriction and dilation. RCVS is associated with nonaneurysmal subarachnoid hemorrhage, pregnancy and exposure to certain drugs. The primary clinical manifestation is recurrent sudden-onset and severe (‘thunderclap’) headaches over 1–3 weeks, often accompanied by nausea, vomiting, photophobia, confusion and blurred vision. The primary diagnostic dilemma is distinguishing RCVS from primary CNS arteritis. Diagnosis requires demonstration of the characteristic ‘string of beads’ on cerebral angiography with resolution within 1–3 months, although many patients will initially have normal vascular imaging. Many treatments have been reported to ameliorate the headaches of RCVS, but it is unclear whether they prevent hemorrhagic or ischemic complications.
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Affiliation(s)
- Ahsan Sattar
- Department of Neurology, University of Wisconsin Hospital and Clinics, 1685 Highland Avenue, Madison, WI 53705-2281, USA
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9
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A case of postpartum cerebral angiitis and review of the literature. Arch Gynecol Obstet 2010; 283:663-8. [DOI: 10.1007/s00404-010-1471-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
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10
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Tønsaas M, Johnsen SH, Seip M, Eldevik P. [Diagnostic challenges in a man with subarachnoidal haemorrhage]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 129:2490-2. [PMID: 19997139 DOI: 10.4045/tidsskr.08.0428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
A 39-year-old man with multiple sclerosis was admitted to the Neurological department because of sudden and intense headache, photophobia, nausea and vomiting. A subarachnoidal haemorrhage was suspected and cerebral CT scanning showed small amounts of subarachnoidal blood distributed symmetrically over both cerebral hemispheres - an unusual location for aneurismal bleeding. Liquor analysis revealed erythrocytes, positive bilirubin and slightly elevated protein. Subsequent cerebral MRI showed no signs of aneurysm, vascular malformation, venous sinus thrombosis or infarction. An intraarterial cerebral angiography was then performed and showed bilateral widespread segmental vasoconstriction in the anterior, middle and posterior cerebral arteries. A diagnostic workup on systemic vasculitis was negative. The patient's good general condition in spite of extensive angiographic findings rendered the diagnosis cerebral vasculitis unlikely. A state of reversible cerebral segmental vasoconstriction was suspected and the patient was treated with the calcium antagonist nifedipine and observed for four weeks. Cerebral angiography was then repeated and found to be normal. This case report highlights a less recognized and probably underdiagnosed cause of subarachnoidal bleeding.
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Affiliation(s)
- Mikal Tønsaas
- Legekontoret Stortorget, Stortorget 4, 9008 Tromsø, Norway.
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11
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Brami F, Domigo V, Godon-Hardy S, Trystram D, Oppenheim C, Méder JF. [Clinical and imaging features of diffuse cerebral vasoconstriction]. JOURNAL DE RADIOLOGIE 2009; 90:1731-1736. [PMID: 19953061 DOI: 10.1016/s0221-0363(09)73272-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To report clinical and imaging features of diffuse cerebral vasoconstriction and to discuss the role of non-invasive imaging modalities for the diagnosis and the follow-up. PATIENTS AND METHODS Retrospective study including 13 consecutive patients with a diffuse cerebral vasoconstriction. Evaluation of the sensitivity of Doppler US and magnetic resonance angiography for the diagnosis. RESULTS The diagnosis is based on the association of a thunderclap headache, declenching factors found in 50% of cases and of stenosis involving middle and small cerebra arteries. In some cases cerebral hemorrhage may be present. DISCUSSION Diffuse cerebral vasoconstriction is a rare cause of thunder clap headhache, which needs to exclude other causes such as subarchnoid hemorrhage from aneurysm rupture. Non contrast CT of the head, frequently normal, may be falsely reassuring. It is therefore necessary to further assess the cerebral arteries to exclude an aneurysm but also to detect the presence of stenoses that would suggest the diagnosis. Non-invasive imaging modalities (MRA and Doppler US) are favored for detection and follow-up of proximal lesions.
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Affiliation(s)
- F Brami
- Service d'Imagerie Médicale, Centre Hospitalier Sainte-Anne, Paris Cedex 14, France.
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12
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Klein M, Fesl G, Pfister HW, Straube A, Brückmann H, Hoffmann LA, Pfefferkorn T. Intra-arterial nimodipine in progressive postpartum cerebral angiopathy. Cephalalgia 2009; 29:279-82. [PMID: 19143773 DOI: 10.1111/j.1468-2982.2008.01728.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M Klein
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
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13
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Moustafa RR, Allen CMC, Baron JC. Call-Fleming syndrome associated with subarachnoid haemorrhage: three new cases. BMJ Case Rep 2009; 2009:bcr09.2008.0989. [PMID: 21686521 DOI: 10.1136/bcr.09.2008.0989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The Call-Fleming syndrome (CFS) comprises acute severe recurrent (thunderclap) headaches, occasional transient or fluctuating neurological abnormalities and reversible segmental cerebral vasoconstriction. It is a benign condition with an excellent prognosis, yet because it is often clinically and radiologically similar to a number of commonly encountered conditions, diagnostic difficulties may arise, leading to inappropriate, and even potentially harmful, investigative and therapeutic approaches. Three personal cases are presented to highlight the occurrence of subarachnoid haemorrhage (SAH) as part of CFS. In two patients with a positive CT head, SAH involved the sulci in the upper cerebral convexity, an unusual location in aneurysmal SAH. SAH is not an uncommon feature of CFS, occurring in approximately 25% of reported cases, and may pose a diagnostic challenge. CFS has a relatively characteristic spectrum of features, allowing a confident diagnosis in most cases, even when atypical features such as SAH are present. Recognising the spectrum of abnormalities seen in CFS, including particularly SAH, allows a sound approach to a safe diagnosis.
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Affiliation(s)
- R R Moustafa
- University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
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14
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Garcin B, Clouston J, Saines N. Reversible cerebral vasoconstriction syndrome. J Clin Neurosci 2008; 16:147-50. [PMID: 19013818 DOI: 10.1016/j.jocn.2008.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 03/17/2008] [Accepted: 03/18/2008] [Indexed: 10/21/2022]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is an under-recognised condition. It is characterised by sudden and severe headaches (of "thunderclap" type) associated with multifocal reversible narrowing of the intracranial arteries on neuroradiology. The diagnosis is often established with the resolution of headaches and vasoconstriction. We report two patients with RCVS and review the available literature, to clarify the diagnostic criteria and discuss the treatment options.
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Affiliation(s)
- Beatrice Garcin
- The Wesley Hospital/Wesley Research Institute, 451 Coronation Drive, Auchenflower, Brisbane, Queensland 4066, Australia
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Edlow BL, Kasner SE, Hurst RW, Weigele JB, Levine JM. Reversible cerebral vasoconstriction syndrome associated with subarachnoid hemorrhage. Neurocrit Care 2008; 7:203-10. [PMID: 17901935 DOI: 10.1007/s12028-007-0058-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Reversible cerebral vasoconstriction syndrome (RCVS) is a rare vasculopathy of unknown etiology. Ischemic stroke and intracerebral hemorrhage are well-documented sequelae, but subarachnoid hemorrhage is an uncommon complication of RCVS. METHODS AND RESULTS We report six cases of RCVS associated with subarachnoid hemorrhage. Two cases occurred in postpartum women, two in women with a history of migraines, one in a woman who recently stopped taking her anti-hypertensive medications, and one in a man after sexual intercourse. All six patients presented with the classic thunderclap headache. Two patients experienced generalized tonic-clonic seizures, and two patients had small ischemic infarcts. Segmental vasoconstriction was demonstrated on cerebral angiography in all six cases. Aneurysmal subarachnoid hemorrhage and other etiologies were excluded. Reversibility of the segmental vasoconstriction was confirmed by follow-up angiography in four patients and by transcranial Doppler sonography in two patients. All six patients had an excellent neurological outcome. CONCLUSIONS Reversible cerebral vasoconstriction syndrome may be associated with subarachnoid hemorrhage. RCVS should be included in the differential diagnosis of non-aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- Brian L Edlow
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA
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