1
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Favrelière S, Mahé J, Veyrac G, Neau JP, Lafay-Chebassier C, Pérault-Pochat MC. Drugs associated with reversible cerebral vasoconstriction syndrome: A pharmacovigilance study in vigiBase ®. Cephalalgia 2024; 44:3331024241267316. [PMID: 39127462 DOI: 10.1177/03331024241267316] [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] [Indexed: 08/12/2024]
Abstract
BACKGROUND Data on drug-induced reversible cerebral vasoconstriction syndrome (RCVS) are scarce. We aimed to describe RCVS characteristics with drugs previously identified as associated with RCVS and investigate potential signals related to other drugs. METHODS VigiBase® was queried for all reports of RCVS until 31 May 2023. A descriptive study was performed on reports concerning drug classes known to precipitate RCVS. To identify new drugs, a disproportionality analysis was conducted. RESULTS In total, 560 reports were included. RCVS occurred in patients aged between 45-64 years (40%) and 18-44 years (35%), mainly in females (72.5%). Drugs were antidepressants (38.4%), triptans (6.4%), nasal decongestants (3.7%) and immunosupressants (8.7%). In 50 cases, antidepressants were in association with drugs known to precipitate RCVS. The median time to onset was 195 days for antidepressants and much shorter (1-10 days) for triptans, nasal decongestants and immunosuppressants. The outcome was favorable in 87% of cases, and fatal in 4.4%. We found a disproportionality signal with 14 drugs: glucocorticoids, bupropion, varenicline, mycophenolic acid, aripiprazole, trazodone, monoclonal antibodies (erenumab, ustekinumab and tocilizumab), leuprorelin and anastrozole. CONCLUSIONS The present study confirms the role of vasoconstrictors in the onset of RCVS, particularly when used in combination and found potential signals, which may help clinicians envisage an iatrogenic etiology of RCVS.
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Affiliation(s)
- Sylvie Favrelière
- Service de Pharmacologie Clinique - Centre Régional de Pharmacovigilance de Poitiers, CHU Poitiers, Poitiers, France
| | - Julien Mahé
- Centre Régional de Pharmacovigilance de Nantes, CHU Nantes, Nantes, France
| | - Gwenaelle Veyrac
- Centre Régional de Pharmacovigilance de Nantes, CHU Nantes, Nantes, France
| | | | - Claire Lafay-Chebassier
- Service de Pharmacologie Clinique - Centre Régional de Pharmacovigilance de Poitiers, CHU Poitiers, Poitiers, France
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2
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Battal B, Castillo M. Imaging of Reversible Cerebral Vasoconstriction Syndrome and Posterior Reversible Encephalopathy Syndrome. Neuroimaging Clin N Am 2024; 34:129-147. [PMID: 37951698 DOI: 10.1016/j.nic.2023.07.004] [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] [Indexed: 11/14/2023]
Abstract
PRES and RCVS are increasingly recognized due to the wider use of brain MRI and increasing clinical awareness. Imaging plays a crucial role in confirming the diagnosis and guiding clinical management for PRES and RCVS. Imaging also has a pivotal role in determining the temporal progression of these entities, detecting complications, and predicting prognosis. In this review, we aim to describe PRES and RCVS, discuss their possible pathophysiological mechanisms, and discuss imaging methods that are useful in the diagnosis, management, and follow-up of patients.
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Affiliation(s)
- Bilal Battal
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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3
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Tentolouris-Piperas V, Lymperopoulos L, Tountopoulou A, Vassilopoulou S, Mitsikostas DD. Headache Attributed to Reversible Cerebral Vasoconstriction Syndrome (RCVS). Diagnostics (Basel) 2023; 13:2730. [PMID: 37685270 PMCID: PMC10487016 DOI: 10.3390/diagnostics13172730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a condition with variable outcomes presenting a new onset thunderclap headache accompanied by focal neurological symptoms or seizures. It can be idiopathic or arise secondarily to a variety of trigger factors. The condition is increasingly recognized in clinical practice, but many facets remain poorly understood. This article aims to clarify the headache characteristics in RCVS, the temporal association of angiographic findings, the potential association of the condition with SARS-CoV-2 infection, and the clinical presentation of RCVS in children and is based on a systematic PRISMA search for published analytical or large descriptive observational studies. Data from 60 studies that fulfilled specific criteria were reviewed. Most people with RCVS exhibit a typical thunderclap, explosive, or pulsatile/throbbing headache, or a similar acute and severe headache that takes longer than 1 min to peak. Atypical presentations or absence of headaches are also reported and may be an underrecognized phenotype. In many cases, headaches may persist after resolution of RCVS. Focal deficits or seizures are attributed to associated complications including transient ischemic attacks, posterior reversible encephalopathy syndrome, ischemic stroke, cerebral edema, and intracranial hemorrhage. The peak of vasoconstriction occurs usually within two weeks after clinical onset, possibly following a pattern of centripetal propagation, and tends to resolve completely within 3 months, well after symptoms have subsided. There are a few reports of RCVS occurring in relation to SARS-CoV-2 infection, but potential underlying pathophysiologic mechanisms and etiological associations have not been confirmed. RCVS occurs in children most often in the context of an underlying disease. Overall, the available data in the literature are scattered, and large-scale prospective studies and international collaborations are needed to further characterize the clinical presentation of RCVS.
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Affiliation(s)
| | | | | | | | - Dimos D. Mitsikostas
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (V.T.-P.); (L.L.); (A.T.); (S.V.)
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4
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Mei JY, Schaefer PW. Ischemic Infarction in Young Adults. Radiol Clin North Am 2023; 61:415-434. [PMID: 36931759 DOI: 10.1016/j.rcl.2023.01.010] [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] [Indexed: 02/21/2023]
Abstract
Ischemic strokes in young adults are increasing in incidence and have emerged as a public health issue. The radiological features are not only diagnostic in identifying ischemic infarctions but also provide important clues in the investigation of the underlying causes or in the identification of risk factors. According to the different imaging patterns associated with ischemic stroke in young adults, the causes can be classified into 5 categories: cardioembolism, large vessel vasculopathy, small vessel vasculopathy, toxic-metabolic, and hypercoagulable disorders. The radiological features of each category and cause are described and summarized in this review.
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Affiliation(s)
- Janet Yanqing Mei
- Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Gray 241G, Boston, MA 02114, USA
| | - Pamela W Schaefer
- Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Gray 241 G, Boston, MA 02114, USA.
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5
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Utukuri PS, Shih RY, Ajam AA, Callahan KE, Chen D, Dunkle JW, Hunt CH, Ivanidze J, Ledbetter LN, Lee RK, Malu O, Pannell JS, Pollock JM, Potrebic SX, Setzen M, Shih RD, Soares BP, Staudt MD, Wang LL, Burns J. ACR Appropriateness Criteria® Headache: 2022 Update. J Am Coll Radiol 2023; 20:S70-S93. [PMID: 37236753 DOI: 10.1016/j.jacr.2023.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Headache is an ancient problem plaguing a large proportion of the population. At present, headache disorders rank third among the global causes of disability, accounting for over $78 billion per year in direct and indirect costs in the United States. Given the prevalence of headache and the wide range of possible etiologies, the goal of this document is to help clarify the most appropriate initial imaging guidelines for headache for eight clinical scenarios/variants, which range from acute onset, life-threatening etiologies to chronic benign scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Robert Y Shih
- Panel Chair, Uniformed Services University, Bethesda, Maryland
| | | | - Kathryn E Callahan
- Wake Forest School of Medicine, Winston Salem, North Carolina; American Geriatrics Society
| | - Doris Chen
- Stanford University, Stanford, California, Primary care physician
| | - Jeffrey W Dunkle
- Indiana University School of Medicine, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Omojo Malu
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia; American Academy of Family Physicians
| | | | | | - Sonja X Potrebic
- Southern California Permanente Medical Group, Pasadena, California; American Academy of Neurology
| | - Michael Setzen
- Weill Cornell Medical College, New York, New York; American Academy of Otolaryngology-Head and Neck Surgery
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - Bruno P Soares
- The University of Vermont Medical Center, Burlington, Vermont
| | - Michael D Staudt
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; American Association of Neurological Surgeons/Congress of Neurological Surgeons
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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6
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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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7
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Balu R, Fischer M. Posterior Reversible Encephalopathy Syndrome. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Spadaro A, Scott KR, Koyfman A, Long B. Reversible cerebral vasoconstriction syndrome: A narrative review for emergency clinicians. Am J Emerg Med 2021; 50:765-772. [PMID: 34879501 DOI: 10.1016/j.ajem.2021.09.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare cause of severe headache that can mimic other causes of sudden, severe headache and result in frequent emergency department (ED) visits. OBJECTIVE This narrative review provides an evidence-based update concerning the presentation, evaluation, and management of RCVS for the emergency clinician. DISCUSSION RCVS can present as recurrent, severe headaches that may be maximal in onset, known as a thunderclap headache. Distinguishing from other causes of thunderclap headache such as aneurysmal subarachnoid hemorrhage, cerebral venous thrombosis, and posterior reversible encephalopathy syndrome is challenging. Risk factors for RCVS include use of vasoactive substances, exertion, coughing, showering, sexual activity, and cervical artery dissection. Diagnosis relies on clinical features and imaging. Cerebral catheter digital subtraction angiography (DSA) is considered the gold standard imaging modality; however, computed tomography angiography or magnetic resonance angiography are reliable non-invasive diagnostic modalities. Treatment focuses on avoiding or removing the offending agent, administration of calcium channel blockers such as nimodipine, and reversing anticoagulation if bleeding is present. Although most cases have a benign course and resolve within 3 months, focal subarachnoid hemorrhage, intracerebral hemorrhage, permanent neurologic disability, or death can occur in a minority of cases. CONCLUSIONS Diagnosis and appropriate management of RCVS can be aided by understanding key aspects of the history and examination. The emergency clinician can then obtain indicated imaging, confirming the diagnosis and allowing for appropriate management.
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Affiliation(s)
- Anthony Spadaro
- Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Kevin R Scott
- Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
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Chai J, Nie H, Wu X, Guan Y, Dai T, Shen Y. The clinical and neuroradiological features of patients of coexisting atraumatic convexity subarachnoid hemorrhage and large artery atherosclerosis stroke: A retrospective observational study. Medicine (Baltimore) 2021; 100:e28155. [PMID: 35049246 PMCID: PMC9191285 DOI: 10.1097/md.0000000000028155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2021] [Indexed: 12/01/2022] Open
Abstract
Atraumatic convexity subarachnoid hemorrhage (c-SAH) concomitant with large artery atherosclerosis (LAA) stroke has been rarely discussed in the literature. Our aim in this study is to characterize the clinical and neuroradiological features of patients with LAA stroke and c-SAH.A retrospective study from a single institution was performed between January 2016 and June 2020. Only patients diagnosed with c-SAH and LAA stoke were included in this study. The clinical presentation and neuroimaging finding were summarized by our experienced neurologists.In total, 12 patients (8 men, 4 women), ranging in age from 45 to 75 years, were identified. All of them had cardiovascular risk factors and hypertension was the commonest (50%). Almost all patients presented hemiparesis (91.7%). Other clinical presentations included, dysarthria (41.7%), hemianesthesia (33.3%), facial palsy (33.3%), aphasia (16.7%), and cognitive impairment (8.3%). Internal border-zone (IBZ) infarction and cortical border-zone (CBZ) infarction occurred in 12 and 3 patients, respectively. c-SAH might occurred in different cortical sulcis. Percentages of frontal lobe, parietal lobe and fronto-parietal lobe were 41.7% (n = 5), 25% (n = 3) and 25% (n = 3), respectively. All ischemic lesions were ipsilateral to the sites of c-SAH. High-grade atherosclerotic stenosis of large artery was detected in all patients. The M1 segment of middle cerebral artery (MCA) is the second most common atherosclerotic artery after internal carotid artery (ICA).Our data suggest that LAA stroke is always ipsilateral to the site of c-SAH. Severe atherosclerotic changes can also been seen in the M1 segment of MCA apart from extracranial ICA. Moreover, border zone infarction may be a specific form of infarct when c-SAH is confronted with LAA stroke.
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Affiliation(s)
- Jingyan Chai
- Department of Neurology, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi Province, China
| | - Hongbing Nie
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiangbin Wu
- Department of Neurology, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi Province, China
| | - Yanqin Guan
- Department of Neurology, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi Province, China
| | - Tingmin Dai
- Department of Neurology, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi Province, China
| | - Yaoyao Shen
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi Province, China
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10
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Sun D, Lv Y, Mo X, Long X, Tian F. Correspondence concerning "Posterior reversible encephalopathy syndrome (PRES) associated with COVID-19". J Clin Neurosci 2021; 93:272-273. [PMID: 34325992 DOI: 10.1016/j.jocn.2021.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Dongren Sun
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Yefan Lv
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Xin Mo
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Xiaoyan Long
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Fafa Tian
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China.
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Miller R, Wagner S, Hammond J, Roberts N, Marshall K, Barth B. Posterior reversible encephalopathy syndrome in the emergency department: A single center retrospective study. Am J Emerg Med 2021; 45:61-64. [PMID: 33667750 DOI: 10.1016/j.ajem.2021.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Posterior Reversible Encephalopathy Syndrome (PRES) and the related term Reversible Posterior Leukoencephalopathy Syndrome (RPLS) denote a constellation of clinical symptoms paired with key radiological findings. These symptoms may include headache, altered mental status, visual changes, and seizures. PRES is a rare condition and remains a challenging diagnosis to make in the emergency department. Data on risk factors and clinical presentation are limited, and there is no recent literature-supported diagnostic criteria. Our primary objective was to identify initial symptoms, clinical presentation, and risk factors that should guide the emergency clinician to consider a diagnosis of PRES. A secondary objective was to identify associations between risk factors and the outcomes of mortality and ICU admissions. METHODS This was a retrospective, observational study that evaluated patients seen in the Emergency Department (ED) in an urban tertiary care center with the diagnosis of PRES or RPLS from 1/1/2008 to 1/1/2018. The Health System's Electronic Medical Record was used to collect data. Search criteria included any patient diagnosed with Posterior Reversible Encephalopathy Syndrome (PRES) or Reversible Posterior Leukoencephalopathy Syndrome (RPLS), and excluded patients under 18 years of age, transfer patients, or patients that were not evaluated in our emergency department. RESULTS We identified 98 patients based on our initial search criteria. After a chart review, 27 patients met our predefined eligibility criteria. In patients with confirmed diagnosis of PRES, the majority were female (70%) and 37% were either on an immunomodulator or undergoing chemotherapy at the time of presentation. 67% of patients presented with altered mental status, 41% had a focal neurologic deficit, and 37% had a witnessed seizure prior to diagnosis. Headache (48%), nausea (33%), and vision changes (30%) were the next most common reported symptoms. The majority of patients were hypertensive at time of presentation (82%) and many had a past medical history of hypertension (78%); twelve were given anti-hypertensive medications. 33% of the patients were admitted to the ICU and 26% died. There were no statistical associations found between documented ED interventions and the outcome of mortality. CONCLUSION PRES is difficult to identify and diagnose in the emergency department. Significant risk factors such as female gender, hypertension, and those currently undergoing active immunotherapy/chemotherapy are associated with PRES. Common presenting complaints and exam findings include headache, altered mental status, and neurologic deficits. Emergency providers should consider PRES in patients presenting with altered mental status with significant risk factors, especially with neurologic deficits for which stroke has been ruled out.
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Affiliation(s)
- Ross Miller
- University of Kansas Medical Center, Kansas City, KS, USA.
| | - Samuel Wagner
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Jordan Hammond
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Nathan Roberts
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Ken Marshall
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley Barth
- University of Kansas Medical Center, Kansas City, KS, USA
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12
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Rustici A, Merli E, Cevoli S, Donato MD, Pierangeli G, Favoni V, Bortolotti C, Sturiale C, Cortelli P, Cirillo L. Vessel-wall MRI in thunderclap headache: A useful tool to answer the riddle? Interv Neuroradiol 2020; 27:219-224. [PMID: 33302764 DOI: 10.1177/1591019920979496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Finding an intracranial aneurysm (IA) during a thunderclap headache (TCH) attack, represents a problem because it is necessary to distinguish whether the aneurysm is responsible for the headache as a warning leak or as an incidental finding. High-Resolution Vessel-Wall (HRVW) MRI sequences have been proposed to assess the stability of the wall, as it permits to detect the presence of aneurysmal wall enhancement (AWE). In fact, AWE has been confirmed due to inflammation, recognizable preceding rupture.Case 1: A 37-year-old woman with a migraine more intense than her usual. A CTA revealed a 10 mm AComA aneurysm without subarachnoid hemorrhage (SAH) and HRVW-MRI excluded AWE. The patient's headache improved, and therefore, the aneurysm was considered an incidental finding, and the headache diagnosed as TCH attack. Subsequently, the aneurysm was surgically clipped, and typical migraine relapsed was reported at follow-up (FU).Case 2: A 67-year-old woman with no history of headaches underwent CTA for an abrupt onset of headache. A 7 mm right carotid-ophthalmic aneurysm with no sign of SAH was discovered. HRVW-MRI demonstrated AWE and thus, a TCH attack for a warning leak of an unstable wall was suspected. Endovascular coiling was immediately performed and at FU any further headache attack was reported. CONCLUSIONS HRVW-MRI is useful in case of finding aneurysm as the cause of headaches, particularly the TCH attack. In fact, HRVW-MRI could assess the stability of the aneurysms wall, allowing different patient management and eventually the aneurysmal treatment.
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Affiliation(s)
- Arianna Rustici
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Elena Merli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica - Rete Neurologica Metropolitana (NeuroMet), Bologna, Italia
| | - Marco Di Donato
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Giulia Pierangeli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica - Rete Neurologica Metropolitana (NeuroMet), Bologna, Italia
| | - Valentina Favoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica - Rete Neurologica Metropolitana (NeuroMet), Bologna, Italia
| | - Carlo Bortolotti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neurochirurgia, Bologna, Italia
| | - Carmelo Sturiale
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neurochirurgia, Bologna, Italia
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica - Rete Neurologica Metropolitana (NeuroMet), Bologna, Italia
| | - Luigi Cirillo
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuroradiologia, Bologna, Italia
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13
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Bax K, Isackson PJ, Moore M, Ambrus JL. Carnitine Palmitoyl Transferase Deficiency in a University Immunology Practice. Curr Rheumatol Rep 2020; 22:8. [PMID: 32067119 DOI: 10.1007/s11926-020-0879-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This report describes the clinical manifestations of 35 patients sent to a University Immunology clinic with a diagnosis of fatigue and exercise intolerance who were identified to have low carnitine palmitoyl transferase activity on muscle biopsies. RECENT FINDINGS All of the patients presented with fatigue and exercise intolerance and many had been diagnosed with fibromyalgia. Their symptoms responded to treatment of the metabolic disease. Associated symptoms included bloating, diarrhea, constipation, gastrointestinal reflux symptoms, recurrent infections, arthritis, dyspnea, dry eye, visual loss, and hearing loss. Associated medical conditions included Hashimoto thyroiditis, Sjogren's syndrome, seronegative arthritis, food hypersensitivities, asthma, sleep apnea, and vasculitis. This study identifies clinical features that should alert physicians to the possibility of an underlying metabolic disease. Treatment of the metabolic disease leads to symptomatic improvement.
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Affiliation(s)
- Kiley Bax
- Department of Medicine, SUNY at Buffalo School of Medicine, Buffalo, NY, USA
| | - Paul J Isackson
- Department of Pediatrics, SUNY at Buffalo School of Medicine, Buffalo, NY, USA
| | - Molly Moore
- Department of Surgery, SUNY at Buffalo School of Medicine, Buffalo, NY, USA
| | - Julian L Ambrus
- Department of Medicine, SUNY at Buffalo School of Medicine, Buffalo, NY, USA.
- Division of Allergy, Immunology and Rheumatology SUNY at Buffalo School of Medicine, Room 8030C, Center for Translational Research, 875 Ellicott Street, Buffalo, NY, 14203, USA.
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14
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Caria F, Zedde M, Gamba M, Bersano A, Rasura M, Adami A, Piantadosi C, Quartuccio L, Azzini C, Melis M, Luisa Delodovici M, Dallocchio C, Gandolfo C, Cerrato P, Motto C, Melis F, Chiti A, Gentile M, Bignamini V, Morotti A, Maria Lotti E, Toriello A, Costa P, Silvestrelli G, Zini A, De Giuli V, Poli L, Paciaroni M, Lodigiani C, Marcheselli S, Sanguigni S, Del Sette M, Monaco S, Lochner P, Zanferrari C, Anticoli S, Padovani A, Pezzini A. The clinical spectrum of reversible cerebral vasoconstriction syndrome: The Italian Project on Stroke at Young Age (IPSYS). Cephalalgia 2019; 39:1267-1276. [DOI: 10.1177/0333102419849013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction To describe clinical, neuroimaging, and laboratory features of a large cohort of Italian patients with reversible cerebral vasoconstriction syndrome. Methods In the setting of the multicenter Italian Project on Stroke at Young Age (IPSYS), we retrospectively enrolled patients with a diagnosis of definite reversible cerebral vasoconstriction syndrome according to the International Classification of Headache Disorders (ICHD)-3 beta criteria (6.7.3 Headache attributed to reversible cerebral vasoconstriction syndrome, imaging-proven). Clinical manifestations, neuroimaging, treatment, and clinical outcomes were evaluated in all patients. Characteristics of reversible cerebral vasoconstriction syndrome without typical causes (“idiopathic reversible cerebral vasoconstriction syndrome”) were compared with those of reversible cerebral vasoconstriction syndrome related to putative causative factors (“secondary reversible cerebral vasoconstriction syndrome”). Results A total of 102 patients (mean age, 47.2 ± 13.9 years; females, 85 [83.3%]) qualified for the analysis. Thunderclap headache at presentation was reported in 69 (67.6%) patients, and it typically recurred in 42 (60.9%). Compared to reversible cerebral vasoconstriction syndrome cases related to putative etiologic conditions (n = 21 [20.6%]), patients with idiopathic reversible cerebral vasoconstriction syndrome (n = 81 [79.4%]) were significantly older (49.2 ± 13.9 vs. 39.5 ± 11.4 years), had more frequently typical thunderclap headache (77.8% vs. 28.6%) and less frequently neurological complications (epileptic seizures, 11.1% vs. 38.1%; cerebral infarction, 6.1% vs. 33.3%), as well as concomitant reversible brain edema (25.9% vs. 47.6%). Conclusions Clinical manifestations and putative etiologies of reversible cerebral vasoconstriction syndrome in our series are slightly different from those observed in previous cohorts. This variability might be partly related to the coexistence of precipitating conditions with a putative etiologic role on disease occurrence.
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Affiliation(s)
- Filomena Caria
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Marialuisa Zedde
- SC Neurologia, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Gamba
- Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy
| | - Anna Bersano
- UO Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Maurizia Rasura
- Stroke Unit, Azienda Ospedaliera Sant’Andrea, Università “La Sapienza”, Rome, Italy
| | - Alessandro Adami
- Stroke Center, Dipartimento di Neurologia, Ospedale Sacro Cuore Negrar, Verona, Italy
| | - Carlo Piantadosi
- UOC Neurologia, Azienda Ospedaliera “San Giovanni-Addolorata”, Rome, Italy
| | - Luca Quartuccio
- Clinica di Reumatologia, Dipartimento di Area Medica, Azienda Ospedaliero-Universitaria “Santa Maria della Misericordia”, Udine, Italy
| | - Cristiano Azzini
- UO di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Maurizio Melis
- SC Neurologia and Stroke Unit, Dipartimento Neuroscienze e Riabilitazione, Azienda Ospedaliera “G. Brotzu”, Cagliari, Italy
| | | | - Carlo Dallocchio
- Dipartimento di Area Medica, UOC Neurologia, ASST Pavia, Voghera, Italy
| | - Carlo Gandolfo
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genoa, Italy
| | - Paolo Cerrato
- Dipartimento di Neuroscienze, Stroke Unit, Università di Torino, Torino, Italy
| | - Cristina Motto
- Stroke Unit, Dipartmento di Scienze Neurologiche, Azienda Ospedaliera “Niguarda Ca’ Granda”, Milan, Italy
| | - Fabio Melis
- SS NeuroVascolare Ospedale Maria Vittoria, ASL Città di Torino, Torino, Italy
| | - Alberto Chiti
- UO Neurologia, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Mauro Gentile
- UO Neurologia – Stroke Unit, Ospedale “Santa Maria della Misericordia”, Rovigo, Italy
| | | | - Andrea Morotti
- UC Malattie Cerebrovascolari, IRCCS Fondazione Mondino, Pavia, Italy
| | | | - Antonella Toriello
- Unità Operativa Complessa Neurologia, Azienda Ospedaliera Universitaria “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Paolo Costa
- UO Neurologia, Istituto Ospedaliero Poliambulanza, Brescia, Italy
| | | | - Andrea Zini
- Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile “S. Agostino Estense”, AUSL Modena, Italy
| | - Valeria De Giuli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Loris Poli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Maurizio Paciaroni
- Stroke Unit and Divisione di Medicina Cardiovascolare, Università di Perugia, Italy
| | - Corrado Lodigiani
- Centro Trombosi e Malattie Emorragiche, Humanitas Clinical and Research Center, IRCCS, Rozzano-Milano, Italy
| | - Simona Marcheselli
- Neurologia d’Urgenza and Stroke Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano-Milano, Italy
| | - Sandro Sanguigni
- Dipartmento di Neurologia, Ospedale “Madonna del Soccorso”, San Benedetto del Tronto, Italy
| | | | | | - Piergiorgio Lochner
- Dipartimento di Neurologia, Saarland University Medical Center, Homburg, Germany
| | - Carla Zanferrari
- UOC Neurologia, ASST Melegnano-Martesana, Vizzolo Predabissi, Italy
| | - Sabrina Anticoli
- Stroke Unit, Dipartimento di Emergenza-Urgenza, Ospedale “S. Camillo-Forlanini”, Rome, Italy
| | - Alessandro Padovani
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Alessandro Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
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15
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Pop A, Carbonnel M, Wang A, Josserand J, Auliac SC, Ayoubi JM. Posterior reversible encephalopathy syndrome associated with reversible cerebral vasoconstriction syndrome in a patient presenting with postpartum eclampsia: A case report. J Gynecol Obstet Hum Reprod 2019; 48:431-434. [PMID: 30905853 DOI: 10.1016/j.jogoh.2019.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 01/03/2023]
Abstract
Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction (RCVS) are rare neurological disorders with complex physiopathology which is not yet fully understood. We present here the case of a 31-year-old woman with a bi-amniotic bi-chorial pregnancy who developed immediate postpartum eclampsia after vaginal delivery, associated with RCVS and PRES. Although post-partum is a well-known precipitating factors for these diseases, to our knowledge, there are only few similar cases reported with the association of these syndromes. Repeated MRI scans were instrumental in the final diagnosis of RCVS associated with PRES, allowing us to give the patient the appropriate treatment. These two syndromes have similar symptoms but may have different treatments, thus highlighting the importance of a correct diagnosis.
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Affiliation(s)
- Antonia Pop
- Department of Gynecology, obstetrics and reproductive medicine, Foch Hospital, Suresnes 92150, France
| | - Marie Carbonnel
- Department of Gynecology, obstetrics and reproductive medicine, Foch Hospital, Suresnes 92150, France.
| | - Adrien Wang
- Department of Neurology, Foch Hospital, Suresnes 92150, France
| | - Julien Josserand
- Department of Anesthesiology, Foch Hospital, Suresnes 92150, France
| | | | - Jean-Marc Ayoubi
- Department of Gynecology, obstetrics and reproductive medicine, Foch Hospital, Suresnes 92150, France
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16
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Arrigan MT, Biller J. Intracranial arteriopathies and RCVS: A discriminatory clinical tool. Neurology 2019; 92:309-310. [PMID: 30635492 DOI: 10.1212/wnl.0000000000006907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Martin T Arrigan
- From the Department of Radiology (M.T.A.), University of British Columbia; Department of Medical Imaging (M.T.A.), Richmond Hospital, Vancouver, Canada; and Department of Neurology (J.B.), Loyola University Chicago, Stritch School of Medicine, Maywood, IL.
| | - José Biller
- From the Department of Radiology (M.T.A.), University of British Columbia; Department of Medical Imaging (M.T.A.), Richmond Hospital, Vancouver, Canada; and Department of Neurology (J.B.), Loyola University Chicago, Stritch School of Medicine, Maywood, IL
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17
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Shen YY, Cheng ZJ, Zhou CG, Dai TM, Nie HB. Reversible Cerebral Vasoconstriction Syndrome following Guillain–Barré Syndrome. Chin Med J (Engl) 2018; 131:2237-2238. [PMID: 30203802 PMCID: PMC6144845 DOI: 10.4103/0366-6999.240793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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