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Jumah A, Albanna AJ, Qureshi M, Malik S. Reversible Cerebral Vasoconstriction Syndrome Secondary to Loperamide Ingestion: A Case Report. Neurohospitalist 2024; 14:186-188. [PMID: 38666269 PMCID: PMC11040623 DOI: 10.1177/19418744231209803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular disorder highlighted by diffuse and multifocal vasoconstriction of the cerebral circulation. This syndrome has been reported to be associated with provoking vasoactive agents, and the identification of such offenders is quite challenging. In our case, the patient's RCVS was caused by the ingestion of loperamide. Although being reported in the cardiac literature, cerebral vasoconstriction due to loperamide has not been reported yet.
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Affiliation(s)
- Ammar Jumah
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | | | - Momina Qureshi
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Shaneela Malik
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
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Ściślicki P, Sztuba K, Klimkowicz-Mrowiec A, Gorzkowska A. Headache Associated with Sexual Activity-A Narrative Review of Literature. ACTA ACUST UNITED AC 2021; 57:medicina57080735. [PMID: 34440941 PMCID: PMC8400207 DOI: 10.3390/medicina57080735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/06/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022]
Abstract
Headache associated with sexual activity (HAWSA) has accompanied humanity since ancient times. However, it is only since the 1970s that it has become the subject of more extensive and detailed scientific interest. The purpose of this review is to provide an overview of the development of the concept of HAWSA, its clinical presentation, etiopathogenesis, diagnosis and treatment especially from the research perspective of the last 20 years. Primary HAWSA is a benign condition, whose etiology is unknown; however, at the first occurrence of headache associated with sexual activity, it is necessary to exclude conditions that are usually immediately life-threatening. Migraine, hypnic headache or hemicrania continua have been reported to co-occur with HAWSA, but their common pathophysiologic basis is still unknown. Recent advances in the treatment of HAWSA include the introduction of topiramate, progesterone, and treatments such as greater occipital nerve injection, arterial embolization, and manual therapy. Whether these new therapeutic options will stand the test of time remains to be seen.
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Affiliation(s)
- Piotr Ściślicki
- Student’s Scientific Society, Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland; (P.Ś.); (K.S.)
| | - Karolina Sztuba
- Student’s Scientific Society, Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland; (P.Ś.); (K.S.)
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland;
| | - Agnieszka Gorzkowska
- Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
- Correspondence:
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3
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Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a condition characterized by thunderclap headache and associated vasospasm of the cerebral vasculature. A multitude of factors are considered to potentially predispose to the development of RCVS. These potential precipitants include numerous illicit drugs. In this study, we investigated the role of illicit drugs as a precipitating factor for RCVS, through systematic review of the relevant literature. We found the strongest evidence for cannabis, but a relative lack of evidence to support other illicit drugs, particularly as individual precipitating factors. We also identified a lack of the consistent application of diagnostic criteria for RCVS, which undoubtedly hampers advancement of knowledge in this field. Consistent adherence to diagnostic criteria will be important for future studies. Ultimately, a prospective registry of RCVS cases would be advantageous to advance understanding of the condition and its underlying causes.
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Affiliation(s)
- Katherine Short
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Hedley C A Emsley
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom.,Department of Neurology, Royal Preston Hospital, Preston, United Kingdom
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Dakay K, Mahta A, Rao S, Reznik ME, Wendell LC, Thompson BB, Potter NS, Saad A, Gandhi CD, Santarelli J, Al-Mufti F, MacGrory B, Burton T, Jayaraman MV, McTaggart RA, Furie K, Yaghi S, Cutting S. Yield of diagnostic imaging in atraumatic convexity subarachnoid hemorrhage. J Neurointerv Surg 2019; 11:1222-1226. [PMID: 31076550 DOI: 10.1136/neurintsurg-2019-014781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Atraumatic convexity subarachnoid hemorrhage is a subtype of spontaneous subarachnoid hemorrhage that often presents a diagnostic challenge. Common etiologies include cerebral amyloid angiopathy, vasculopathies, and coagulopathy; however, aneurysm is rare. Given the broad differential of causes of convexity subarachnoid hemorrhage, we assessed the diagnostic yield of common tests and propose a testing strategy. METHODS We performed a single-center retrospective study on consecutive patients with atraumatic convexity subarachnoid hemorrhage over a 2-year period. We obtained and reviewed each patient's imaging and characterized the frequency with which each test ultimately diagnosed the cause. Additionally, we discuss clinical features of patients with convexity subarachnoid hemorrhage with respect to the mechanism of hemorrhage. RESULTS We identified 70 patients over the study period (mean (SD) age 64.70 (16.9) years, 35.7% men), of whom 58 patients (82%) had a brain MRI, 57 (81%) had non-invasive vessel imaging, and 27 (38.5%) underwent catheter-based angiography. Diagnoses were made using only non-invasive imaging modalities in 40 patients (57%), while catheter-based angiography confirmed the diagnosis in nine patients (13%). Further clinical history and laboratory testing yielded a diagnosis in an additional 17 patients (24%), while the cause remained unknown in four patients (6%). CONCLUSION The etiology of convexity subarachnoid hemorrhage may be diagnosed in most cases via non-invasive imaging and a thorough clinical history. However, catheter angiography should be strongly considered when non-invasive imaging fails to reveal the diagnosis or to better characterize a vascular malformation. Larger prospective studies are needed to validate this algorithm.
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Affiliation(s)
- Katarina Dakay
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ali Mahta
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Shyam Rao
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Michael E Reznik
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Linda C Wendell
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Bradford B Thompson
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - N Stevenson Potter
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ali Saad
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Justin Santarelli
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Brian MacGrory
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Tina Burton
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Mahesh V Jayaraman
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Diagnostic Imaging, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ryan A McTaggart
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Diagnostic Imaging, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Karen Furie
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Shawna Cutting
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
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Abstract
BACKGROUND Paroxysmal neurological symptoms occurring with sex cause considerable anxiety and sometimes have a serious cause. Thunderclap headache is the most well-known and requires urgent investigation at first presentation for subarachnoid haemorrhage and other significant pathologies. After exclusion of underlying causes, many prove to be primary headache associated with sexual activity. Orgasmic migraine aura without headache is not currently recognised as a clinical entity. CASE REPORTS We report two patients with acephalgic orgasmic neurological symptoms fulfilling the criteria for migraine aura. CONCLUSIONS The incidence of acephalgic orgasmic migraine aura is unknown. It should be considered as part of the differential of paroxysmal sex-related neurological symptoms, and clinically differentiated from fixed deficits, reversible cerebral vasoconstriction syndrome and post-orgasmic illness syndrome.
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Affiliation(s)
- Heather Angus-Leppan
- 1 Clinical Neurosciences, Royal Free London NHS Foundation Trust, London, UK.,2 University College London, London, UK.,3 Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
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