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Lee DE, Krishnan A, Collins R. Reversible cerebral vasoconstriction syndrome in the postpartum period: A case report and review of the literature. Int J Gynaecol Obstet 2023; 162:823-828. [PMID: 36965125 DOI: 10.1002/ijgo.14756] [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: 12/06/2022] [Revised: 02/24/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare phenomenon that can present in the postpartum period. We show the experience of a 35-year-old patient who presented with headache after an uncomplicated pregnancy and vaginal delivery. She was initially diagnosed with pre-eclampsia, and subsequently with RCVS following discovery of multifocal vascular narrowing on magnetic resonance arteriography (MRA). Verapamil was initiated, and at 1 month there was improvement intracranially, but cervical vertebral arterial narrowing, likely dissection, was discovered. Verapamil was continued and aspirin was initiated. Follow-up imaging 5 months postpartum demonstrated near-complete resolution of previously noted abnormalities, which remained stable at reimaging at 10 months postpartum. In conclusion, the symptoms of RCVS can mimic or coexist with pre-eclampsia. Early intracranial imaging such as MRA can permit timely diagnosis and facilitate appropriate management and follow-up.
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Affiliation(s)
- David E Lee
- Department of Obstetrics & Gynecology, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Anant Krishnan
- Department of Diagnostic Radiology and Molecular Imaging, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Riley Collins
- Department of Obstetrics & Gynecology, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
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Bonura A, Iaccarino G, Rossi SS, Capone F, Motolese F, Calandrelli R, Di Lazzaro V, Pilato F. Posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome in patients with COVID-19 infection: is there a link? A systematic review and case report analysis. J Neurol 2023; 270:2826-2852. [PMID: 37014421 PMCID: PMC10071475 DOI: 10.1007/s00415-023-11684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/26/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
During the SARS-CoV2 pandemic, several cases of Posterior Reversible Encephalopathy Syndrome (PRES) and of Reversible Cerebral Vasoconstriction Syndrome (RCVS) in COVID-19 patients have been reported, but the link between these syndromes and COVID-19 is unclear. We performed a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to evaluate whether SARS-CoV2 infection or the drugs used to treat it could be deemed potential risk factors for PRES or RCVS. We performed a literature search. We found 70 articles (60 on PRES and 10 on RCVS) concerning n = 105 patients (n = 85 with PRES, n = 20 with RCVS). We analyzed the clinical characteristics of the two populations separately, then performed an inferential analysis to search for other independent risk factors. We found fewer than usual PRES-related (43.9%) and RCVS-related (45%) risk factors in patients with COVID-19. Such a low incidence of risk factors for PRES and RCVS might suggest the involvement of COVID-19 as an additional risk factor for both diseases due to its capability to cause endothelial dysfunction. We discuss the putative mechanisms of endothelial damage by SARS-CoV2 and antiviral drugs which may underlie the development of PRES and RCVS.
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Affiliation(s)
- Adriano Bonura
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Gianmarco Iaccarino
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Sergio Soeren Rossi
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Francesco Motolese
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Rosalinda Calandrelli
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Fabio Pilato
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
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Caranzano L, Fenter H, Maeder P, Michel P, Strambo D. Pearls & Oy-sters: Postdural Puncture Headache, Cerebral Sinus Venous Thrombosis, and Reversible Cerebral Vasoconstriction Syndrome in the Peripartum Period. Neurology 2022; 99:665-668. [PMID: 35948451 DOI: 10.1212/wnl.0000000000201111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/30/2022] [Indexed: 11/15/2022] Open
Abstract
We report the case of a 34-year-old female patient complaining of headaches 1 day after childbirth, initially interpreted as postdural puncture headache (PDPH) and treated successfully with an epidural blood patch. Five days later, she presented with an acute proportional right sensorimotor hemisyndrome and a new-onset left-sided headache, attributed to a venous stroke from left-sided cerebral sinus venous thrombosis (CSVT). Simultaneously, we found radiologic signs of reversible cerebral vasoconstriction syndrome (RCVS), considered asymptomatic. We administered anticoagulant therapy to the patient, and she showed full motor recovery at 3-month clinical follow-up. PDPH, CSVT, and RCVS are well-known neurologic complications during the peripartum period. All 3 conditions present with headaches, and headache features may overlap, masking co-occurrence and making accurate diagnosis (differentiation) of these diseases difficult. Each disease can potentially lead to disabling deficits, but all respond to specific treatment. Knowledge of the causes of headaches in the peripartum period, their specific clinical characteristics, and potential complications helps to prioritize and interpret diagnostic tests to offer appropriate therapy.
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Affiliation(s)
- Leonardo Caranzano
- From the Department of Clinical Neurosciences (L.C., H.F., P. Michel, D.S.), Neurology Service, and Department of Medical Radiology (P. Maeder), Radiodiagnostic and Interventional Radiology Service, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Helene Fenter
- From the Department of Clinical Neurosciences (L.C., H.F., P. Michel, D.S.), Neurology Service, and Department of Medical Radiology (P. Maeder), Radiodiagnostic and Interventional Radiology Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Philippe Maeder
- From the Department of Clinical Neurosciences (L.C., H.F., P. Michel, D.S.), Neurology Service, and Department of Medical Radiology (P. Maeder), Radiodiagnostic and Interventional Radiology Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Patrik Michel
- From the Department of Clinical Neurosciences (L.C., H.F., P. Michel, D.S.), Neurology Service, and Department of Medical Radiology (P. Maeder), Radiodiagnostic and Interventional Radiology Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Davide Strambo
- From the Department of Clinical Neurosciences (L.C., H.F., P. Michel, D.S.), Neurology Service, and Department of Medical Radiology (P. Maeder), Radiodiagnostic and Interventional Radiology Service, Lausanne University Hospital and University of Lausanne, Switzerland
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Zhang D, Chen Y, Wang J, Hu X. Intracranial hypotension as a contributor to isolated cortical vein thrombosis. Headache 2022; 62:212-219. [PMID: 35137399 DOI: 10.1111/head.14254] [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: 05/11/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Isolated cortical vein thrombosis (ICVT), a rare type of cerebral venous thrombosis (CVT), is diagnostically challenging in some cases, and intracranial hypotension (IH) is known to cause CVT. METHODS In this study, we reviewed the clinical and imaging characteristics of ICVT in patients with IH caused by spinal cerebrospinal fluid leakage, based on a literature review and investigation of cases from our hospital. RESULTS Between January 1, 2007, and November 1, 2019, 735 patients were diagnosed with IH at our hospital; three patients developed ICVT (incidence ~ 0.4%, 3/735), and the literature review yielded an additional 23 cases. Therefore, 26 patients (mean age 35.9 ± 11.4 years old) were included in this study. The most common symptoms were headache (100.0%, 26/26), focal neurological deficits (53.8%, 14/26), and seizure (34.6%, 9/26). The initial headache was orthostatic in 96.2% (25/26) of patients, and 38.5% (10/26) of patients reported a change in the headache pattern following diagnosis of ICVT. Neuroimaging findings associated with ICVT included the cord sign (61.5%, 16/26) and parenchymal brain lesions (46.2%, 12/26), such as intracerebral hemorrhage (30.8%, 8/26), hemorrhagic infarcts (11.5%, 3/26), and localized edema (11.5%, 3/26). The percentage of patients who received anticoagulation and epidural blood patch therapy was similar (69.2% [18/26] vs. 65.4% [17/26]), and most patients recovered completely (92.3%, 24/26). CONCLUSION IH should be considered in the differential diagnosis in patients with ICVT. Knowledge of the relevant clinical and neuroimaging features is important to facilitate early diagnosis for favorable prognosis.
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Affiliation(s)
- Dan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Yin Chen
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Jin Wang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Xingyue Hu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
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Chambers DJ, Bhatia K, Columb M. Postpartum cerebral venous sinus thrombosis following obstetric neuraxial blockade: a literature review with analysis of 58 case reports. Int J Obstet Anesth 2021; 49:103218. [PMID: 34598860 DOI: 10.1016/j.ijoa.2021.103218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/17/2021] [Accepted: 09/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is a rare complication of pregnancy. It usually presents with a headache and may mimic a post-dural puncture headache (PDPH) in women who receive a neuraxial block. METHODS Medline, CINAHL and EMBASE databases were searched to identify postpartum cases of CVST following neuraxial block. The aim was to delineate the characteristics, presentation, investigations, and outcomes of postpartum women who presented with CVST. RESULTS Forty-nine articles with 58 case reports were identified. Forty-two women (72.4%) had an epidural attempted whilst 16 women (27.6%) received a spinal anaesthetic. Accidental dural puncture (ADP) was reported in 17 women (40.5%). Headache was the presenting symptom in 57 women (98.3%); 26 women (44.8%) also experienced seizures. Post-dural puncture headache was reported in 46 (79.3%) and an epidural blood patch was performed in 26 women (44.8%). Superior sagittal sinus, transverse sinus, and cortical veins were the most common sites of thrombosis. The median time to diagnosis was 6.5 days from delivery. Magnetic resonance imaging was the most common diagnostic neuro-imaging modality. Full neurological recovery was reported in 48 (82.8%), whilst neurological deficits were reported in six (10.3%) women. DISCUSSION The diagnosis of CVST may be overlooked in women who present with headache following neuraxial block. A change in character of headache with loss of postural element, and focal neurological signs are the key clinical features that could help anaesthetists differentiate headache of CVST from PDPH. The high reported rates of ADP and PDPH lend support to their possible association with CVST.
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Affiliation(s)
| | - K Bhatia
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.
| | - M Columb
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
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Garg A, Rajendram P, Muccilli A, Noel de Tilly L, Micieli JA. Dural venous sinus thrombosis after lumbar puncture in a patient with idiopathic intracranial hypertension. Eur J Ophthalmol 2020; 32:1120672120970406. [PMID: 33176472 DOI: 10.1177/1120672120970406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Idiopathic intracranial hypertension (IIH) is one of the most common causes of papilloedema seen by ophthalmologists and neurologists. Patients with IIH routinely undergo lumbar puncture (LP) for diagnosis. Dural venous sinus thrombosis (DVST) is a rare complication of cerebrospinal fluid pressure (CSF)-lowering procedures such as lumbar puncture and epidural and may be an intracranial complication of IIH. CASE DESCRIPTION A 29-year-old obese woman was diagnosed with severe idiopathic intracranial hypertension (IIH) after she presented with new-onset headache, pulsatile tinnitus and blurred vision. Magnetic resonance imaging (MRI) and venography (MRV) were normal apart from signs of intracranial hypertension. Lumbar puncture (LP) revealed an opening pressure of 40 cm of water. Due to the severity of the papilloedema and vision loss, she was referred for a ventriculoperitoneal shunt and found to have venous sinus thrombosis involving the superior sagittal sinus on the pre-operative computed tomography (CT) head 5 days after the LP. CT venography (CTV) one day later and MRV 3 days later showed significant worsening as the thrombosis extended into the deep venous system. She was started on therapeutic heparin and her symptoms and vision improved and she did not develop any neurological complications. CONCLUSIONS DVST should be considered in IIH patients who have worsening papilloedema or symptoms of intracranial hypertension. Repeat venous imaging can prevent devastating consequences such as venous infarcts of haemorrhage in these patients.
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Affiliation(s)
- Anubhav Garg
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Phavalan Rajendram
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Muccilli
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lyne Noel de Tilly
- Department of Medical Imaging, Division of Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan A Micieli
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Vision and Research Centre, Toronto, Ontario, Canada
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Ohshima T, Tamari Y, Yamamoto T, Goto S, Ishikawa K. Midterm Follow-Up of 20 Consecutive Patients with Nonaneurysmal Subarachnoid Hemorrhage of Unknown Origin in a Single-Center: Two Cases of De Novo Development of Dural Arteriovenous Fistula. J Stroke Cerebrovasc Dis 2017; 26:2788-2792. [PMID: 28802521 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.061] [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: 06/12/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE The mechanisms and prognosis of underlying subarachnoid hemorrhage of unknown origin remain unclear. Previous investigators have suggested a relationship between nonaneurysmal perimesencephalic subarachnoid hemorrhage and venous abnormalities like a primitive venous drainage of the basal vein of Rosenthal. We report the outcome of a midterm follow-up of 20 consecutive patients with nonaneurysmal subarachnoid hemorrhage of unknown origin, and 2 patients in whom the development of new dural arteriovenous fistulas after subarachnoid hemorrhage of unknown origin were detected during follow-up. METHODS All patients who were admitted to our hospital for nontraumatic subarachnoid hemorrhage between April 2008 and March 2016 were retrospectively analyzed. RESULTS Of 705 patients included in the study, 20 (2.8%) were diagnosed with nontraumatic subarachnoid hemorrhage of unknown origin. During the follow-up periods, there was no rebleeding. Although 18 patients did not show any vascular abnormalities, the other 2 patients were diagnosed with dural arteriovenous fistula. Both fistulas were successfully treated with endovascular embolization. CONCLUSIONS Subarachnoid hemorrhage of unknown origin had a low incidence rate, and its clinical course was excellent without rebleeding. Although no vascular abnormalities were observed during the patients' initial admission, venous lesions might have been involved in both subarachnoid hemorrhages and delayed dural arteriovenous fistulas. Here, the possible pathogenesis is discussed with a review of the literature.
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Affiliation(s)
- Tomotaka Ohshima
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
| | - Yosuke Tamari
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Taiki Yamamoto
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Kojiro Ishikawa
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
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Abstract
Background Altered cerebrovascular tone is implicated in reversible cerebral vasoconstriction syndrome (RCVS). We evaluated vasomotor reactivity using bedside transcranial Doppler in RCVS patients. Methods In this retrospective case-control study, middle cerebral artery (MCA) blood flow velocities were compared at rest and in response to breath-hold in RCVS ( n = 8), Migraineurs ( n = 10), and non-headache Controls ( n = 10). Hyperventilation response was measured in RCVS. Results In RCVS, Breath Holding Index (BHI) was severely reduced in seven of eight patients and 14/16 MCAs; seven of 16 MCAs showed exhausted (BHI < 0.1) or inverted (BHI < 0) vasomotor reactivity. Mean BHI in RCVS (0.23 ± 0.5) was significantly lower than Migraine (1.52 ± 0.57) and Controls (1.51 ± 0.32), p < 0.001. Triphasic velocity responses were seen in all groups. The maximum Vmean decline during the middle negative phase was −15.5 ± 9.2% in RCVS, −15.4 ± 7% in Migraine, and −10.3 ± 5% in Controls ( p = 0.04). In the late positive phase, average Vmean increase was 6.2 ± 14% in RCVS, which was significantly lower ( p < 0.001) than Migraine (30.5 ± 11%) and Controls (30.2 ± 6%). With hyperventilation, RCVS patients showed 23% decrease in Vmean. Conclusion Cerebral arterial tone is abnormal in RCVS, with proximal vasoconstriction and abnormally reduced capacity for vasodilation. Further studies are needed to determine the utility of BHI to diagnose RCVS before angiographic reversibility is established, and to estimate prognosis.
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Bourvis N, Franc J, Szatmary Z, Chabriat H, Crassard I, Ducros A. Reversible cerebral vasoconstriction syndrome in the context of recent cerebral venous thrombosis: Report of a case. Cephalalgia 2015; 36:92-7. [PMID: 25944816 DOI: 10.1177/0333102415584359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 04/05/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Reversible cerebral constriction syndrome and cerebral venous thrombosis are two rare conditions. Reversible cerebral constriction syndrome affects the cerebral arteries and the pathology is still largely unknown. To date, no physiological link with cerebral venous thrombosis has been reported. CASE RESULTS We report here the case of a 24-year-old woman who presented a reversible cerebral constriction syndrome in the setting of a cerebral venous thrombosis. Cerebral venous thrombosis had developed in her left lateral venous sinus, within the stent placed one year before, in order to treat an idiopathic intracranial hypertension. DISCUSSION The co-occurrence of cerebral venous thrombosis and reversible cerebral constriction syndrome in the same patient raises the issue of a potential link between them. We discuss the potential common trigger factors in this case: recent hormonal therapy; intracranial hypotension iatrogenically induced by lumbar puncture.
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Affiliation(s)
- Nadège Bourvis
- Neurology Department, Lariboisière Hospital, Paris, France Headache Emergency Centre, Lariboisière Hospital, Paris, France
| | - Julie Franc
- Neuroradiology Department, Lariboisière Hospital, Paris, France
| | - Zoltan Szatmary
- Neuroradiology Department, Lariboisière Hospital, Paris, France
| | | | | | - Anne Ducros
- Neurology Department, Lariboisière Hospital, Paris, France Headache Emergency Centre, Lariboisière Hospital, Paris, France
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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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Humbertjean L, Ducrocq X, Lacour JC, Mione G, Richard S. Incidental Diagnosis of Cerebral Cortical Venous Thrombosis in Postdural Puncture Headache on Brain Computed Tomography. J Neuroimaging 2014; 25:665-7. [PMID: 25510263 DOI: 10.1111/jon.12203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/20/2014] [Accepted: 09/13/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lisa Humbertjean
- Department of Neurology; University Hospital of Nancy; Nancy France
| | - Xavier Ducrocq
- Department of Neurology; University Hospital of Nancy; Nancy France
| | | | - Gioia Mione
- Department of Neurology; University Hospital of Nancy; Nancy France
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12
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Gonen KA, Taskapilioglu O, Dusak A, Hakyemez B. Persistent headache in a postpartum patient: the investigation and management. BMJ Case Rep 2013; 2013:bcr-2013-009931. [PMID: 23813512 DOI: 10.1136/bcr-2013-009931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Postdural puncture headache (PDPH) is the most common complication of obstetric regional anaesthesia and the most likely cause of headache in a woman who underwent epidural anaesthesia during delivery. Cerebral venous sinus thrombosis (CVST) is an uncommon cause of postpartum headache. Anaesthesia in obstetrics may lead to long-lasting intracranial hypotension resulting in CVST. CVST is a serious pathology with high mortality if misdiagnosed, but its correct and rapid diagnosis offers the opportunity for early treatment. Cranial magnetic resonance imaging (MRI) is an important modality in the diagnosis of both CVST and intracranial hypotension. The latter condition may be treated either by an epidural blood patch or bed rest and hydration. We report a case of a 36-year-old woman who developed CVST and multiple venous infarcts after an attempted epidural procedure during delivery. She was treated conservatively with bed rest, hydration and low-molecular-weight heparin and the patient recovered completely.
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Affiliation(s)
- Korcan Aysun Gonen
- Department of Radiology, Namik Kemal University, School of Medicine, Tekirdag, Turkey.
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13
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Abstract
Recurrent thunderclap headaches, seizures, strokes, and non-aneurysmal subarachnoid haemorrhage can all reveal reversible cerebral vasoconstriction syndrome. This increasingly recognised syndrome is characterised by severe headaches, with or without other symptoms, and segmental constriction of cerebral arteries that resolves within 3 months. Reversible cerebral vasoconstriction syndrome is supposedly due to a transient disturbance in the control of cerebrovascular tone. More than half the cases occur post partum or after exposure to adrenergic or serotonergic drugs. Manifestations have a uniphasic course, and vary from pure cephalalgic forms to rare catastrophic forms associated with several haemorrhagic and ischaemic strokes, brain oedema, and death. Diagnosis can be hampered by the dynamic nature of clinicoradiological features. Stroke can occur a few days after initial normal imaging, and cerebral vasoconstriction is at a maximum on angiograms 2-3 weeks after clinical onset. The calcium channel blocker nimodipine seems to reduce thunderclap headaches within 48 h of administration, but has no proven effect on haemorrhagic and ischaemic complications.
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Affiliation(s)
- Anne Ducros
- Emergency Headache Centre, Head and Neck Clinic, Lariboisière Hospital, Paris, France.
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14
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Ding Y, Fredrickson V, Lin Y, Piao Y, Wang X, Lu D, Li C. Atypical clinical and pathological findings in a patient with isolated cortical vein thrombosis. Neural Regen Res 2012; 7:2473-9. [PMID: 25337098 PMCID: PMC4200722 DOI: 10.3969/j.issn.1673-5374.2012.31.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/10/2012] [Indexed: 11/02/2022] Open
Abstract
Isolated cortical vein thrombosis often produces a focal lesion. Because of the rapid development of collateral circulation, increased intracranial pressure has never been reported in a patient with isolated cortical vein thrombosis. The diagnosis of isolated cortical vein thrombosis is based mainly on MRI, catheter digital subtraction angiography, and histological findings, but may be challenging. We report a patient who presented with intermittent seizures and left-sided limb weakness. Her symptoms gradually progressed, and she eventually developed signs of increased intracranial pressure. Imaging studies showed a space-occupying lesion in the right frontal lobe of the brain. As we could not diagnose isolated cortical vein thrombosis based on the preoperative findings, surgical excision of the lesion was performed under general anesthesia. Histological examination showed destruction of the brain parenchyma with infiltration of macrophages, proliferation of reactive astrocytes and small vessels, and foci of hemorrhage. Further examination found that a number of small vessels in both the subarachnoid space and brain parenchyma were filled with thrombus, some of which was organized. Elastic fiber staining showed that the obstructed vessels were veins. We diagnosed isolated cortical vein thrombosis with atypical clinical features.
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Affiliation(s)
- Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Vance Fredrickson
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yueshan Piao
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiangbo Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Dehong Lu
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Cunjiang Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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15
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Abstract
Background and Purpose—
Postpartum angiopathy (PPA), a rare cause of stroke in the puerperium, is heralded by severe headaches within 1–2 weeks after delivery. Angiography demonstrates segmental vasoconstriction that often resolves spontaneously. PPA is generally regarded as benign. We aimed to define clinical presentations, radiological findings, and outcomes of patients with PPA.
Methods—
We retrospectively reviewed patients from 3 centers with acute neurological symptoms and angiography showing vasoconstriction in the postpartum period. Patients without neuroimaging and with diagnoses of cerebral venous sinus thrombosis and aneurysmal hemorrhage were excluded. Patient characteristics, clinical symptoms, neuroimaging findings, and clinical condition at hospital discharge were collected.
Results—
Eighteen patients (mean age, 31 years; range, 15–41) were identified. Median gestation was 38 weeks. Twelve (67%) had a history of prior uneventful pregnancy. Neurological symptoms began on median day 5 postpartum and included headache (n=16, 89%), focal deficit (n=9, 50%), visual disturbance (n=8, 44%), encephalopathy (n=6, 33%), and seizure (n=5, 28%), often in combination. Brain imaging was abnormal in most (n=13, 72%). The most common abnormalities were intracranial hemorrhage (n=7, 39%), vasogenic edema (n=6, 35%), and infarction (n=6, 35%). Clinical outcomes were markedly variable with full recovery seen in 9 (50%), death after a fulminant course in 4 (22%), and residual deficits in 5 (28%).
Conclusions—
In contrast to prior reports, this group of patients with PPA had a higher proportion of nonbenign outcomes. Most patients who undergo neuroimaging have parenchymal abnormalities, which are most often stroke (hemorrhagic or ischemic) or reversible vasogenic edema.
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Peripartum angiopathy with simultaneous sinus venous thrombosis, cervical artery dissection and cerebral arterial vasoconstriction. J Neurol 2011; 258:2080-2. [DOI: 10.1007/s00415-011-6047-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/04/2011] [Accepted: 04/05/2011] [Indexed: 11/27/2022]
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17
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Nerve injuries after neuraxial anaesthesia and their medicolegal implications. Best Pract Res Clin Obstet Gynaecol 2010; 24:367-81. [PMID: 20053587 DOI: 10.1016/j.bpobgyn.2009.11.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 11/25/2009] [Indexed: 11/21/2022]
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18
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Wong SH, Dougan C, Chatterjee K, Fletcher NA, White RP. Recurrent Thunderclap Headaches and Multilobar Intracerebral Haemorrhages: Two Cases of Reversible Cerebral Vasoconstriction Syndrome (RCVS). Cephalalgia 2009; 29:791-5. [DOI: 10.1111/j.1468-2982.2008.01805.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe two patients with thunderclap headaches due to reversible cerebral vasoconstriction syndrome (RCVS). The first patient illustrates multilobar intracerebral haemorrhages as an under-appreciated feature of RCVS, and the second illustrates recurrent thunderclap headache (presumed recurrent RCVS) after a long interval of 4 years. These cases demonstrate the spectrum of presentation of RCVS, a clinically under-recognized condition.
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Affiliation(s)
- SH Wong
- The Walton Centre for Neurology NHS Neurosurgery NHS Trust, Liverpool
| | - C Dougan
- The Walton Centre for Neurology NHS Neurosurgery NHS Trust, Liverpool
| | | | - NA Fletcher
- The Walton Centre for Neurology NHS Neurosurgery NHS Trust, Liverpool
| | - RP White
- The Walton Centre for Neurology NHS Neurosurgery NHS Trust, Liverpool
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Fletcher JJ, Kramer AH, Bleck TP, Solenski NJ. Overlapping features of eclampsia and postpartum angiopathy. Neurocrit Care 2009; 11:199-209. [PMID: 19404782 DOI: 10.1007/s12028-009-9221-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Postpartum cerebral angiopathy (PPA) is considered one of a diverse group of rare conditions termed "reversible cerebral vasoconstriction syndromes". Existing literature suggest considerable overlap in the manifestations of eclampsia and PPA. METHODS Retrospective case series review of PPA and eclampsia from a single neurosciences intensive care unit patient log identified over a consecutive 18-month period. A MEDLINE search (using OVID) of the English literature from 1950 through October 2008 was also performed. RESULTS Four patients who meet the obstetrical criteria for eclampsia and four patients whose clinical and radiographic features were consistent with PPA were identified. Twenty-eight patients with PPA were identified from the literature and showed significant clinical and radiographic overlap without cohort. CONCLUSION Given the overlapping clinical, laboratory, and radiographical features of eclampsia and PPA, it is probable they share a similar underlying pathophysiological mechanism and represent different clinical expressions of the same pregnancy-related disorder. The obstetrical definition of eclampsia may be to strict when applied in the neurosciences intensive care unit.
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Affiliation(s)
- Jeffrey J Fletcher
- Department of Medicine, Michigan State University, Bronson Methodist Hospital, 601 John Street Suite M-124, Kalamazoo, MI 49007, USA.
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Abstract
PURPOSE OF REVIEW The treatment of postdural puncture headache remains controversial, largely because it is insufficiently evidence based. With high rates of neuraxial block in the obstetric population likely to continue, postdural puncture headache will remain a primary cause of morbidity and increased duration of hospital stay. This review describes new reports of relevance published in 2006 and until October 2007. RECENT FINDINGS New evidence justifies epidural blood patch as the treatment of choice for severe postdural puncture headache, but technical aspects such as optimal timing and volume are less clear. Symptomatic medical management remains diverse, with a multitude of therapies often advocated, despite a lack of scientific support. Reports of misdiagnosis and of complications associated with postdural puncture headache and its treatment emphasize the importance of multidisciplinary management and additional investigation, including radiological imaging, when the clinical picture warrants. SUMMARY The key reports in this epoch have shed light on the benefits of careful assessment of postpartum headache and treatment with an epidural blood patch. New management paradigms have been suggested and serious complications continue to be reported.
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