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Elfil M, Lookian PP, Kumari K, Aladawi M, Jedras M, Phillips SM, Sattur MG. Reversible cerebral vasoconstriction syndrome due to teprotumumab: two case reports. Oxf Med Case Reports 2024; 2024:omae085. [PMID: 39119013 PMCID: PMC11304978 DOI: 10.1093/omcr/omae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Reversible Cerebral Vasoconstriction Syndrome (RCVS) involves cerebral vasculature constriction and dilation. While the exact pathophysiology of RCVS is still not fully understood, there are multiple etiological factors suggested to be implicated in triggering RCVS. We report two RCVS cases potentially linked to teprotumumab. Case 1: A 59-year-old female with Graves' eye disease (GED) developed leg weakness and headache after initiating teprotumumab, and neuroimaging studies revealed multifocal cerebral vasospasm (CVS). Verapamil mitigated vasospasm and the patient overall improved. Case 2: A 71-year-old female with GED developed thunderclap headache two months after starting teprotumumab, with subarachnoid hemorrhage (SAH) and CVS revealed on neuroimaging studies. The patient improved on verapamil and was discharged without deficits. CONCLUSIONS The temporal correlation between teprotumumab initiation and RCVS's symptom onset raises concern for the potential involvement of teprotumumab in triggering RCVS via disrupting cerebrovascular modulation. Further research is needed to investigate this proposed association.
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Affiliation(s)
- Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440, United States
| | - Pashayar P Lookian
- Department of Neurosurgery, University of Nebraska Medical Center, 4242 Farnam St., Omaha, NE 68131, United States
| | - Kanchan Kumari
- Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440, United States
| | - Mohammad Aladawi
- Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440, United States
| | - Mark Jedras
- Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440, United States
| | - Steven M Phillips
- Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440, United States
| | - Mithun G Sattur
- Department of Neurosurgery, University of Nebraska Medical Center, 4242 Farnam St., Omaha, NE 68131, United States
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Prucnal CK, Shappell EF, Wittels KA, Monette DL. A Case of Thunderclap Headache and Neurologic Deficits. J Emerg Med 2024:S0736-4679(24)00086-6. [PMID: 38834390 DOI: 10.1016/j.jemermed.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 06/06/2024]
Affiliation(s)
- Christiana K Prucnal
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eric F Shappell
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen A Wittels
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Derek L Monette
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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Borhani-Haghighi A, Hooshmandi E. Cerebral venous thrombosis: a practical review. Postgrad Med J 2024; 100:68-83. [PMID: 37978050 DOI: 10.1093/postmj/qgad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023]
Abstract
The evolution of the Coronavirus Disease-2019 pandemic and its vaccination raised more attention to cerebral venous thrombosis (CVT). Although CVT is less prevalent than arterial stroke, it results in larger years of life lost. CVT is more common in women and young patients. Predisposing factors are categorized as transient factors such as pregnancy, puerperium, oral contraceptive pills, trauma, and dehydration; and permanent factors such as neoplastic, vasculitic, thrombophilic, hematologic conditions, infectious causes such as severe acute respiratory syndrome coronavirus-2 infection and HIV. The most common manifestations are headache, seizures, focal neurologic deficits, altered level of consciousness, and cranial nerve palsies. The most common syndromes are stroke-like, raised-intracranial-pressure (ICP), isolated-headache, and encephalopathy, which may have overlaps. Diagnosis is mostly based on computed tomography, magnetic resonance imaging, and their respective venous sequences, supported by blood results abnormalities such as D-dimer elevation. Treatment includes the prevention of propagation of current thrombus with anticoagulation (heparin, or low molecular weight heparinoids and then warfarin, or direct oral anticoagulants), decreasing ICP (even by decompressive craniotomy), and treatment of specific underlying diseases.
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Affiliation(s)
- Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
- Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia
| | - Etrat Hooshmandi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
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Ribas MZ, Paticcié GF, de Medeiros SDP, de Oliveira Veras A, Noleto FM, dos Santos JCC. Reversible cerebral vasoconstriction syndrome: literature review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023; 59:5. [PMID: 36647436 PMCID: PMC9833030 DOI: 10.1186/s41983-023-00607-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a neurovascular condition characterized by a severe sudden-onset headache that may be associated with focal neurological deficits. On imaging, the suggestive finding corresponds to multifocal vasoconstriction of the cerebral arteries, with a spontaneous resolution of approximately 12 weeks. The identification of precipitating factors and diagnosis must be carried out early, so that adequate management is established and the patient has a good prognosis, given the risk of secondary complications and residual neurological deficits. This study consists of a literature review based on the analysis of articles published between 2017 and 2022 in PubMed, SciELO, and ScienceDirect on RCVS, intending to understand the clinical and radiological characteristics, diagnosis, treatment, and prognosis of patients with RCVS. The pathophysiology, drug management, and prognosis still lack solid evidence; therefore, further studies on RCVS are needed to expand medical knowledge and avoid underdiagnosis and inadequate treatment of this important condition.
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Affiliation(s)
| | - Gabriela Ferreira Paticcié
- grid.411198.40000 0001 2170 9332Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, MG Brazil
| | | | - Arthur de Oliveira Veras
- grid.11899.380000 0004 1937 0722Clinical Hospital of the Faculty of Medicine of Ribeirão Preto - USP, Ribeirão Prêto, SP Brazil
| | - Felipe Micelli Noleto
- grid.510399.70000 0000 9839 2890Faculty of Medicine, Christus University Center, UNICHRISTUS, Fortaleza, CE Brazil
| | - Júlio César Claudino dos Santos
- grid.411249.b0000 0001 0514 7202Neurosciences Laboratory, Department of Neurology and Neurosurgery, Federal University of São Paulo, Sena Madureira, 1500, Vila Clementino (SP), São Paulo, SP 04021-001 Brazil
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Thewes B, Lehnen NC, Bode F, Dorn F, Strizek B, Diedrich AK, Hilbert T. [Seizure with intracranial hemorrhage after cesarean section in spinal anesthesia]. DIE ANAESTHESIOLOGIE 2023; 72:28-31. [PMID: 36167845 PMCID: PMC9852116 DOI: 10.1007/s00101-022-01203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Ben Thewes
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Nils Christian Lehnen
- grid.15090.3d0000 0000 8786 803XKlinik für Neuroradiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Felix Bode
- grid.15090.3d0000 0000 8786 803XKlinik für Neurologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Franziska Dorn
- grid.15090.3d0000 0000 8786 803XKlinik für Neuroradiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Brigitte Strizek
- grid.15090.3d0000 0000 8786 803XAbteilung für Geburtshilfe und Pränatale Medizin, Zentrum für Geburtshilfe und Frauenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Anna Katharina Diedrich
- grid.15090.3d0000 0000 8786 803XAbteilung für Geburtshilfe und Pränatale Medizin, Zentrum für Geburtshilfe und Frauenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Tobias Hilbert
- grid.15090.3d0000 0000 8786 803XKlinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Deutschland
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