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Arici C, Mergen B. Exercise-Induced Idiopathic Nasal Hemianopsia in a Young Professional Athlete. J Neuroophthalmol 2024:00041327-990000000-00612. [PMID: 38573772 DOI: 10.1097/wno.0000000000002137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- Ceyhun Arici
- Istanbul University-Cerrahpasa (CA), Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul, Turkey; and Department of Ophthalmology (BM), University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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2
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Singhal AB. Reversible cerebral vasoconstriction syndrome: A review of pathogenesis, clinical presentation, and treatment. Int J Stroke 2023; 18:1151-1160. [PMID: 37246916 DOI: 10.1177/17474930231181250] [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: 05/30/2023]
Abstract
Reversible segmental narrowing of the intracranial arteries has been described since several decades in numerous clinical settings, using variable nosology. Twenty-one years ago, we tentatively proposed the unifying concept that these entities, based on similar clinical-imaging features, represented a single cerebrovascular syndrome. This "reversible cerebral vasoconstriction syndrome" or RCVS has now come of age. A new International Classification of Diseases code, (ICD-10, I67.841) has been established, enabling larger-scale studies. The RCVS2 scoring system provides high accuracy in confirming RCVS diagnosis and excluding mimics such as primary angiitis of the central nervous system. Several groups have characterized its clinical-imaging features. RCVS predominantly affects women. Recurrent worst-ever (thunderclap) headaches are typical at onset. While initial brain imaging is often normal, approximately one-third to half develop complications such as convexity subarachnoid hemorrhages, lobar hemorrhages, ischemic strokes located in arterial "watershed" territories and reversible edema, alone or in combination. Vasoconstriction evolves over hours to days, first affecting distal and then the more proximal arteries. An overlap between RCVS and primary thunderclap headache, posterior reversible encephalopathy syndrome, Takotsubo cardiomyopathy, transient global amnesia, and other conditions has been recognized. The pathophysiology remains largely unknown. Management is mostly symptomatic: headache relief with analgesics and oral calcium-channel blockers, removal of vasoconstrictive factors, and avoidance of glucocorticoids that can significantly worsen outcome. Intra-arterial vasodilator infusions provide variable success. Overall, 90-95% of admitted patients achieve complete or major resolution of symptoms and clinical deficits within days to weeks. Recurrence is exceptional, although 5% can later develop isolated thunderclap headaches with or without mild cerebral vasoconstriction.
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Affiliation(s)
- Aneesh B Singhal
- Neurology Department, Massachusetts General Hospital, Boston, MA, USA
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Sun RL, Chhabra A, Patel A, Shaltoni H. Reversible cerebral vasoconstriction syndrome after levonorgestrel-releasing intrauterine device placement-Case report. Headache 2023; 63:700-704. [PMID: 37140063 DOI: 10.1111/head.14515] [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: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is a disease characterized by reversible multifocal narrowing of the cerebral arteries with clinical manifestations that typically include thunderclap headache and occasionally brain edema, stroke, or seizure. The exact pathophysiology of RCVS is not well known. CASE A 46-year-old female with history of episodic migraine presented with 1-month duration of worsening headaches that had become more severe over the past 2 weeks. The headaches were episodic and thunderclap in onset and aggravated by physical exertion or emotional situations. A neurological examination was unremarkable including initial head computed tomography (CT). A CT angiogram of the head showed multifocal stenosis in the right anterior cerebral artery, bilateral middle cerebral arteries, and right posterior cerebral artery. Cerebral angiogram confirmed the CT angiogram findings. A repeated CT angiogram a few days later showed improvement in the multifocal cerebral arterial stenosis. Lumbar puncture and autoimmune workup were not suggestive of neuroinflammatory etiology. She had one generalized tonic-clonic seizure during her second day of hospitalization. The patient's thunderclap onset headaches resolved in 1 week after she was managed with blood pressure control and pain medication. She denied any illicit drug use or any new medications other than the placement of a levonorgestrel-releasing intrauterine device (IUD) about 6 weeks prior to her presentation. CONCLUSIONS Our case suggests a possible link between RCVS and levonorgestrel-releasing IUDs.
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Affiliation(s)
- Ruiqing L Sun
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Arun Chhabra
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Anand Patel
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Hashem Shaltoni
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, 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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Chen SP, Wang SJ. Pathophysiology of reversible cerebral vasoconstriction syndrome. J Biomed Sci 2022; 29:72. [PMID: 36127720 PMCID: PMC9489486 DOI: 10.1186/s12929-022-00857-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a complex neurovascular disorder being recognized during the past two decades. It is characterized by multiple abrupt severe headaches and widespread cerebral vasoconstrictions, with potential complications such as ischemic stroke, convexity subarachnoid hemorrhage, intracerebral hemorrhage and posterior reversible encephalopathy syndrome. The clinical features, imaging findings, and dynamic disease course have been delineated. However, the pathophysiology of RCVS remains elusive. Recent studies have had substantial progress in elucidating its pathogenesis. It is now believed that dysfunction of cerebral vascular tone and impairment of blood–brain barrier may play key roles in the pathophysiology of RCVS, which explains some of the clinical and radiological manifestations of RCVS. Some other potentially important elements include genetic predisposition, sympathetic overactivity, endothelial dysfunction, and oxidative stress, although the detailed molecular mechanisms are yet to be identified. In this review, we will summarize what have been revealed in the literature and elaborate how these factors could contribute to the pathophysiology of RCVS.
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Affiliation(s)
- Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 11217, Taiwan. .,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan. .,Brain Research Center & School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 11217, Taiwan. .,Brain Research Center & School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Kirschen GW, Hoyt K, Johnson E, Patel S. Eclampsia with RCVS: Postpartum seizure provoked by methergine. Pregnancy Hypertens 2022; 27:131-133. [DOI: 10.1016/j.preghy.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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Boitet R, de Gaalon S, Ducros A. Sindrome da vasocostrizione cerebrale reversibile. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Singhal AB. Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome as Syndromes of Cerebrovascular Dysregulation. Continuum (Minneap Minn) 2021; 27:1301-1320. [PMID: 34618761 DOI: 10.1212/con.0000000000001037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article describes the causes, clinical and imaging features, management, and prognosis of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS), in which the underlying pathophysiology is related to reversible dysregulation of the cerebral vasculature. RECENT FINDINGS PRES and RCVS are descriptive terms, each bringing together conditions with similar clinical-imaging manifestations. Headache, visual symptoms, seizures, and confusion occur in both syndromes. RCVS is usually heralded by recurrent thunderclap headaches, whereas encephalopathy and seizures are typical in PRES. In PRES, brain imaging shows reversible vasogenic edema that is typically symmetric and located in subcortical regions (mostly posterior predominant). In RCVS, brain imaging is often normal; cerebral angiography shows segmental vasoconstriction-vasodilatation affecting the circle of Willis arteries and their branches. Aside from shared clinical features, significant imaging overlap exists. Both PRES and RCVS can be complicated by ischemic and hemorrhagic brain lesions; angiographic abnormalities frequently occur in PRES and vasogenic edematous lesions in RCVS. Common triggers (eg, eclampsia, vasoconstrictive and chemotherapeutic agents) have been identified. Abnormal cerebrovascular tone and endothelial dysfunction may explain both syndromes. Management of these syndromes includes the removal of identified triggers, symptomatic treatment of headache or seizures, and moderate blood pressure control. Both syndromes are self-limited, with clinical recovery occurring within days to weeks. Long-term deficits and mortality are uncommon. SUMMARY PRES and RCVS have been well characterized and acknowledged to have significant overlap. Advances in our understanding of pathophysiology and risk factors for poor outcome are expected to optimize the management of these not uncommon syndromes.
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Houlihan LM, Halloran PJO, Lynch J, Widdess-Walsh P, Brennan P, Javadpour M. Reversible cerebral vasoconstrictive syndrome preceded by minor head trauma. Br J Neurosurg 2020; 34:647-649. [DOI: 10.1080/02688697.2019.1672858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- L. M. Houlihan
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P. J. O' Halloran
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J. Lynch
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P. Widdess-Walsh
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P. Brennan
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M. Javadpour
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rocha EA, Singhal AB. Current Treatment Options in Cardiovascular Medicine: Update on Reversible Cerebral Vasoconstriction Syndrome. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00819-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Shimizu Y, Tsuchiya K, Fujisawa H. Reversible cerebral vasoconstriction syndrome concomitant with cerebral venous sinus thrombosis following ovarian tumor resection: A report of two cases. Surg Neurol Int 2020; 11:128. [PMID: 32547815 PMCID: PMC7294317 DOI: 10.25259/sni_578_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Reversible cerebral vasoconstriction syndrome (RCVS) presents with characteristic clinical, brain imaging, and angiographic findings. The most common clinical feature of RCVS is a severe acute headache, which is often referred to as a thunderclap headache due to the nature of its presentation. It may occur spontaneously or may be provoked by various precipitating factors. We present a rare case of RCVS concomitant with cerebral venous sinus thrombosis (CVST) in a woman who underwent resection of an ovarian tumor. Case Description: Case 1 – A 42-year-old woman was admitted to our hospital with severe headache radiating to the neck, with associated vomiting. She revealed a medical history of ovarian cancer and underwent an operation for the resection of the tumor, a month before presentation. After resection, her estradiol (E2) levels were reduced from 288 pg/ml to 31 pg/ml (normal range, 0–49 pg/ml). Initial imaging on admission to our hospital revealed the left posterior convexity subarachnoid hemorrhage. Magnetic resonance angiography (MRA) showed findings consistent with RCVS affecting the left posterior cerebral artery. Magnetic resonance venography (MRV) showed CVST of the left transverse and sigmoid sinuses. Single-photon emission computed tomography (SPECT) showed a left posterior ischemic lesion. These findings improved following treatment with nimodipine and anticoagulant. Case 2 – A 39-year-old woman presented with holocranial headache associated with vomiting. She was diagnosed with an ovarian tumor. She underwent an operation 3 months before presentation. After tumor resection, her E2 level decrease from 193 pg/ml to 19 pg/ml (normal range, 0–49 pg/ml). Magnetic resonance angiography (MRA) confirmed the presence of a vasospasm involving the right anterior cerebral artery. Magnetic resonance venography (MRV) confirmed the presence of thrombosis involving the superior sagittal sinus. She was discharged on postpartum day 31 without neurological deficits after treatment with anticoagulants. At her 3-month follow-up, both MRA and MRV were within the normal limits. Conclusion: This is the first report of two women diagnosed with RCVS with concomitant CVST following ovarian tumor resection. Marked reductions in postoperative E2 levels could have contributed to the development of CVST and RCVS.
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Affiliation(s)
- Yu Shimizu
- Department of Neurosurgery, Shimoishibikimachi, Kanazawa, Ishikawa, Japan
| | - Katsuhiro Tsuchiya
- Department of Neurosurgery, Kanazawa Medical Center, Shimoishibikimachi, Kanazawa, Ishikawa, Japan
| | - Hironori Fujisawa
- Department of Neurosurgery, Kanazawa Medical Center, Shimoishibikimachi, Kanazawa, Ishikawa, Japan
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Murali S, Miller K, McDermott M. Preeclampsia, eclampsia, and posterior reversible encephalopathy syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:63-77. [PMID: 32768095 DOI: 10.1016/b978-0-444-64240-0.00004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Preeclampsia is a disorder of pregnancy associated with gestational hypertension and end-organ dysfunction. Patients with eclampsia, by definition, have seizures as part of the clinical syndrome. However, patients with preeclampsia can also have other neurologic symptoms and deficits. Both disorders can be associated with radiographic abnormalities similar to that of posterior reversible encephalopathy syndrome, suggesting a common pathophysiology or unified clinical spectrum of disorders. This chapter reviews the pathophysiology, clinical presentation, diagnostic findings, and prognosis of patients with neurologic complications associated with preeclampsia and eclampsia.
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Affiliation(s)
- Sadhana Murali
- Department of Neurology, University of Michigan Stroke Program, Ann Arbor, MI, United States
| | - Kristin Miller
- Department of Neurology, University of Illinois at Chicago, Stroke Program, Chicago, IL, United States
| | - Mollie McDermott
- Department of Neurology, University of Michigan Stroke Program, Ann Arbor, MI, United States.
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Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome: Distinct Clinical Entities with Overlapping Pathophysiology. Radiol Clin North Am 2019; 57:1133-1146. [PMID: 31582040 DOI: 10.1016/j.rcl.2019.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The clinical and radiologic manifestations of posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome are reviewed. The relationship between these entities is discussed. A hypothesis of a common underlying pathophysiology is proposed and substantiated based on the current medical literature.
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El Hassani MEM, Benali S, Kouach J, Rahali DM. [Posterior reversible encephalopathy syndrome: a case report]. Pan Afr Med J 2019; 33:154. [PMID: 31558951 PMCID: PMC6754829 DOI: 10.11604/pamj.2019.33.154.16630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
Abstract
L'encéphalopathie postérieure réversible (EPR) est une entité radio-clinique associant une atteinte réversible du système nerveux central à une imagerie encéphalique typique. Il existe une grande variabilité dans la présentation clinique de ce syndrome et des aspects en imagerie parfois atypiques. L'EPR est une complication neurologique inhabituelle survenant au cours de la grossesse ou en post-partum, en dehors de toute pathologie préexistante de la grossesse dont l'œdème vasogénique par rupture de la barrière hémato encéphalique paraît être l'acteur principal. Nous rapportons l'observation d'une patiente primipare présentant des crises convulsives généralisées tonico-cloniques associées à un pic hypertensif, survenant au cours du troisième trimestre de grossesse. L'imagerie par résonance magnétique (IRM) cérébrale était en faveur d'une encéphalopathie postérieure réversible. L'EPR doit être évoqué devant tout signe d'appel neurologique, vu l'évolution favorable sans séquelles sous un traitement précoce et rapide.
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Affiliation(s)
| | - Saad Benali
- Service de Gynécologie Obstétrique, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Jaouad Kouach
- Service de Gynécologie Obstétrique, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Driss Moussaoui Rahali
- Service de Gynécologie Obstétrique, Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
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Reversible Cerebral Vasoconstriction Syndrome after Administering Etanercept during Puerperium. J Stroke Cerebrovasc Dis 2019; 28:e10-e11. [PMID: 30630756 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/28/2018] [Accepted: 12/16/2018] [Indexed: 11/24/2022] Open
Abstract
Our objective is to clarify relationship between reversible cerebral vasoconstriction syndrome and administrating etanercept during puerperium. Several lines of evidence have suggested tumor necrosis factor (TNF) as a mediator of vascular dysfunction associated with estrogen deficiency. A 32-year-old woman resumed etanercept (25 mg/week), a TNF inhibitor, which had been discontinued during pregnancy, because of the deterioration of rheumatoid arthritis. She was admitted to our hospital with upper right quadrant blindness and mild right hemiparesis accompanied by pulsating left occipital pain, which had appeared 4 hours after restarting etanercept (25 mg/week). Magnetic resonance imaging and angiography revealed acute left hippocampal infarction with multiple segmental stenoses of the main intracranial arteries. Reversible cerebral vasoconstriction syndrome was diagnosed based on improvement of the multiple stenoses on magnetic resonance angiography on hospital day 17. A causal relationship was considered to exist between TNF inhibition by etanercept and multiple cerebral vasoconstrictions with brain infarct in this puerperant.
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Topcuoglu MA, McKee KE, Singhal AB. Gender and hormonal influences in reversible cerebral vasoconstriction syndrome. Eur Stroke J 2016; 1:199-204. [PMID: 31008280 DOI: 10.1177/2396987316656981] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/04/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction The reversible cerebral vasoconstriction syndromes, including postpartum angiopathy, have been characterized over the last decade. Women are predominantly affected. Some studies suggest that postpartum angiopathy carries a worse prognosis. Patients and methods We compared the clinical, neuroimaging, and angiographic features of 36 men, 110 non-pregnant women and 16 postpartum women included in our single-center cohort of patients with reversible cerebral vasoconstriction syndromes encountered from 1998 to 2016. Results As compared to men, non-pregnant women were older (48 ± 11 vs. 34 ± 13 years, p < 0.001), had more underlying migraine (49% vs. 19%, p = 0.002), depression (53% vs. 14%, p < 0.001) and serotonergic antidepressant use (45% vs. 11%, p < 0.001), developed more clinical worsening (18% vs. 3%, p = 0.022), more infarcts (39% vs. 20%, p = 0.031) and worse angiographic severity scores (23 ± 14 vs. 10.9 ± 10.3, p < 0.001), but had similar discharge outcomes (modified Rankin scale scores 0-3, 90% vs. 91%, p = 0.768). Sexual activity was an important trigger in men (22% vs. 4%, p = 0.002). As compared to non-pregnant women, postpartum angiopathy patients were younger (33 ± 6 years, p < 0.001) and had less vasoconstrictive drug exposure (25% vs. 67%, p = 0.002) but showed similar clinical, radiological and angiographic findings and similar discharge outcomes (modified Rankin scale scores 0-3 in 94%, p = 0.633). There were no significant differences between pre- and post-menopausal women, or those with and without hysterectomy. Discussion/Conclusion The observed gender differences in reversible cerebral vasoconstriction syndromes may result from hormonal or non-hormonal factors. Hormonal imbalances may trigger reversible cerebral vasoconstriction syndromes. Given the absence of significant differences in the female subgroups, hormonal factors do not appear to significantly affect the course or outcome of reversible cerebral vasoconstriction syndromes.
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Affiliation(s)
- Mehmet A Topcuoglu
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, USA.,Neurology Department, Hacettepe University Hospitals, Turkey
| | - Kathleen E McKee
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, USA
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Jolobe O. Reversible cerebral vasoconstriction syndrome might account for the headaches simulating subarachnoid haemorrhage. QJM 2016; 109:217. [PMID: 26253298 DOI: 10.1093/qjmed/hcv134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O Jolobe
- From the Department of Medicine, Manchester Medical Society, Manchester, UK
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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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Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course. AJNR Am J Neuroradiol 2015; 36:1392-9. [PMID: 25593203 DOI: 10.3174/ajnr.a4214] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Reversible cerebral vasoconstriction syndrome is a clinical and radiologic syndrome that represents a common presentation of a diverse group of disorders. The syndrome is characterized by thunderclap headache and reversible vasoconstriction of cerebral arteries, which can either be spontaneous or related to an exogenous trigger. The pathophysiology of reversible cerebral vasoconstriction syndrome is unknown, though alterations in cerebral vascular tone are thought to be a key underlying mechanism. The syndrome typically follows a benign course; however, reversible cerebral vasoconstriction syndrome may result in permanent disability or death in a small minority of patients secondary to complications such as ischemic stroke or intracranial hemorrhage.
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Affiliation(s)
- T R Miller
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - R Shivashankar
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - M Mossa-Basha
- Department of Diagnostic Radiology (M.M.-B.), Section of Neuroradiology, University of Washington, Seattle, Washington
| | - D Gandhi
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
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Kuo CY, Yen MF, Chen LS, Fann CY, Chiu YH, Chen HH, Pan SL. Increased risk of hemorrhagic stroke in patients with migraine: a population-based cohort study. PLoS One 2013; 8:e55253. [PMID: 23372843 PMCID: PMC3555928 DOI: 10.1371/journal.pone.0055253] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 12/24/2012] [Indexed: 11/18/2022] Open
Abstract
Objective Previous studies on the association between migraine and the risk of developing hemorrhagic stroke (HS) have generated inconsistent results. The aim of the present population-based, age- and sex- matched follow-up study was to investigate whether migraine is associated with an increased risk of HS. Method A total of 20925 persons with at least two ambulatory visits in 2001 with the principal diagnosis of migraine were enrolled in the migraine group. The non-migraine group consisted of 104625, age- and sex- matched, randomly sampled subjects without migraine. The two-year HS-free survival rates for these 2 groups were estimated using the Kaplan-Meier method. Cox proportional hazards regression was used to estimate the effect of migraine on the occurrence of HS. Results During the 2 year follow-up, 113 subjects in the migraine group (0.54%) and 255 in the non-migraine group (0.24%) developed HS. The crude hazard ratio (HR) for developing HS in the migraine group was 2.22 compared to the non-migraine group (95% confidence interval [CI]: 1.78–2.77, p<0.0001) and the adjusted HR was 2.13 (95% CI: 1.71–2.67, p<0.0001) after controlling for demographic characteristics and comorbid medical disorders. Conclusions This population-based age- and sex- matched cohort study shows that migraine was linked to an increased risk of HS.
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Affiliation(s)
- Cheng-Ya Kuo
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Yuan Fann
- Department of Nutrition and Health Sciences, Kainan University, Taoyuan, Taiwan
| | - Yueh-Hsia Chiu
- Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Hsiu-Hsi Chen
- Centre of Biostatistics Consultation, College of Public Health, National Taiwan University, Taipei, Taiwan
- Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shin-Liang Pan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail:
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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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Reversible Cerebral Vasoconstriction Syndrome 3 Months after Blood Transfusion. J Stroke Cerebrovasc Dis 2012; 21:915.e1-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/21/2011] [Accepted: 01/20/2012] [Indexed: 11/21/2022] Open
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Matsuyama Y, Satake M. [A case of reversible cerebral vasoconstriction syndrome (RCVS) triggered by human placenta extract]. Rinsho Shinkeigaku 2012; 52:182-185. [PMID: 22453044 DOI: 10.5692/clinicalneurol.52.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a case of a female patient with reversible cerebral vasoconstriction syndrome (RCVS) arising after receiving subcutaneous injection of human placenta extract. A 44-year-old woman started taking human placenta extract with the aim of improving her menopausal symptoms, fatigue, and beauty. However, 18 days after taking human placenta extract, she had three episodes of thunderclap headache. Repeated cranial CT did not show subarachnoid hemorrhage; CSF examination showed neither xanthochromia nor inflammation. Brain diffusion weighted and FLAIR images were normal. However, magnetic resonance angiography showed multifocal segmental stenosis of the right middle cerebral artery and bilateral anterior cerebral arteries. Follow-up angiography, which performed 12 days after the oncet of thunderclap headache, revealed almost normalized flow in all cerebral arteries; we made a diagnosis of RCVS. She has had no symptoms and signs since the third attack of headache. The only identified etiologic factor was subcutaneous injection of human placenta extract started 18 days prior to onset. This is the first report of RCVS triggered by human placenta extract.
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Krämer M, Berlit P. [Reversible cerebral vasoconstriction syndrome vs cerebral vasculitis? On the importance and difficulty of differentiating]. DER NERVENARZT 2011; 82:500, 502, 504-5. [PMID: 21153582 DOI: 10.1007/s00115-010-3189-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M Krämer
- Klinik für Neurologie mit klinischer Neurophysiologie, Alfried-Krupp-Krankenhaus, Alfried-Krupp-Straße 21, 45117, Essen.
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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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Noda K, Fukae J, Fujishima K, Mori K, Urabe T, Hattori N, Okuma Y. Reversible cerebral vasoconstriction syndrome presenting as subarachnoid hemorrhage, reversible posterior leukoencephalopathy, and cerebral infarction. Intern Med 2011; 50:1227-33. [PMID: 21628940 DOI: 10.2169/internalmedicine.50.4812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute severe headache with or without additional neurological symptoms and reversible cerebral vasoconstriction. Unruptured aneurysm has been reported in some cases with RCVS. We report a severe case of a 53-year-old woman with RCVS having an unruptured cerebral aneurysm and presenting as cortical subarachnoid hemorrhage, reversible posterior leukoencephalopathy syndrome, and cerebral infarction. She was successfully treated with corticosteroids and a calcium channel blocker and the aneurysm was clipped. Her various complications are due to the responsible vasoconstriction that started distally and progressed towards proximal arteries. This case demonstrates the spectrum of presentations of RCVS, a clinically complicated condition.
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Affiliation(s)
- Kazuyuki Noda
- Department of Neurology, Juntendo University Shizuoka Hospital, Japan.
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Freilinger T, Schmidt C, Duering M, Linn J, Straube A, Peters N. Reversible cerebral vasoconstriction syndrome associated with hormone therapy for intrauterine insemination. Cephalalgia 2010; 30:1127-32. [DOI: 10.1177/0333102409360675] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) comprises a heterogeneous group of acute neurological diseases which are characterized by thunderclap headache and evidence of reversible multifocal constriction of cerebral arteries. A number of precipitating factors have been described in the literature, including recent childbirth and use of vasoactive substances. Case description: Here we present the case of a female patient with RCVS which occurred in the setting of hormonal ovarian stimulation for intrauterine insemination. Discussion: This case possibly contributes to the understanding of the pathophysiological mechanisms underlying reversible cerebral vasoconstriction.
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Affiliation(s)
- T Freilinger
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - C Schmidt
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - M Duering
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - J Linn
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - A Straube
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - N Peters
- Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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