scholarly journals Grief-induced reversible cerebral vasoconstriction syndrome (RCVS)

2020 ◽  
Vol 13 (1) ◽  
pp. e232204
Author(s):  
Pooja Rao ◽  
Michael Francis McCullough ◽  
Jessica Stevens ◽  
Matthew A Edwardson
Keyword(s):  
Bipolar Disorder ◽  
Brain Injury ◽  
Medical History ◽  
External Ventricular Drain ◽  
Causative Factor ◽  
Severe Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction ◽  
History Of ◽  
Subarachnoid Blood

Stress is under-recognised as a potential causative factor for reversible cerebral vasoconstriction syndrome (RCVS). Here we present a case of RCVS occurring during a time of extreme emotional duress. A 46-year-old female patient with medical history of bipolar disorder developed a severe headache during her father’s funeral. The following day she was discovered to have bilateral hemiparesis, aphasia, encephalopathy and was brought emergently to the hospital. Neuroimaging revealed a 33 mL left fronto-parietal haematoma with subarachnoid blood near the vertex bilaterally. She underwent craniotomy, haematoma evacuation and external ventricular drain placement. The patient received two cerebral angiograms, the first showing multifocal cerebral vasoconstriction and the second showing resolution of these changes. She improved significantly over the course of her 3-week hospitalisation and eventually made a full recovery, including the ability to speak fluently in six languages with no significant deficits other than hypersomnia; she now requires 10 hours of sleep each night as compared with 7 hours prior to her brain injury.

scholarly journals Reversible Cerebral Vasoconstriction Syndrome Associated with Infundibular Dilation

2020 ◽  
Author(s):  
Héctor Montenegro-Rosales ◽  
Blanca Karina González-Alonso ◽  
Omar Cárdenas-Sáenz ◽  
Alonso Gutierrez-Romero
Keyword(s):  
Cerebral Arteries ◽  
Imaging Study ◽  
Sudden Onset ◽  
Severe Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Initial Image ◽  
Case Presentation ◽  
Cerebral Vasoconstriction ◽  
History Of ◽  
Visual Disturbances

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is defined as a clinical and radiological syndrome that comprises a group of disorders characterized by sudden-onset severe headache and segmental vasoconstriction of the cerebral arteries with resolution within 3 months. Case presentation: A 51-year-old female patient with a 2-week history of sudden-onset severe headache, visual disturbances and cerebellum; no relevant imaging findings, except for an infundibular dilation at the origin of the posterior communicating artery, and so, angiography was performed. When symptoms persisted, a new imaging study was carried out with findings of RCVS as the cause of the symptoms from the beginning. Conclusions: Findings of RCVS can be obtained in various vasculopathies of the nervous system and vasculitis, being misdiagnosed, and so, clinical suspicion is essential; if vasoconstriction is not demonstrated on the initial image and other diagnoses have been excluded, the patient should be managed as having possible or probable RCVS.

Abstract P686: Ischemic Stroke in Reversible Cerebral Vasoconstriction Syndrome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Aayushi Garg ◽  
Amjad Elmashala ◽  
Santiago Ortega
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Survey Design ◽  
Inpatient Rehabilitation ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Hospital Charges ◽  
Multivariable Logistic Regression Analysis ◽  
Cerebral Vasoconstriction ◽  
History Of

Introduction: Ischemic stroke is the cause for major morbidity and mortality in reversible cerebral vasoconstriction syndrome (RCVS). While there is evidence to suggest that ischemic stroke in RCVS is associated with proximal vasoconstriction, it is still unclear why some patients develop ischemic lesions. The aim of this study was to evaluate the risk factors and outcomes of ischemic stroke in RCVS. Methods: We utilized the Nationwide Readmissions Database 2016-2017 to identify all hospitalizations with the discharge diagnosis of RCVS. Occurrence of acute ischemic stroke was identified. Hospitalizations with the diagnosis of hemorrhagic stroke were excluded. Survey design methods were used to generate national estimates. Independent predictors of ischemic stroke were analyzed using multivariable logistic regression analysis with results expressed as odds ratio (OR) and 95% confidence intervals (CI). Results: Among the total 1,065 hospitalizations for RCVS during the study period (mean±SD age: 49.0±16.7 years, female 69.7%), 267 (25.1%) had occurrence of acute ischemic stroke. Patients with ischemic stroke were more likely to have history of hypertension (OR 2.33, 95% CI 1.51-3.60), diabetes (OR 1.81, 95% CI 1.11-2.98), and tobacco use (OR 1.64, 95% CI 1.16-2.33) and less likely to have a history of migraine (OR 0.56, 95% CI 0.35-0.90). Patients with stroke were more likely to develop cerebral edema. They also had longer hospital stay, higher hospital charges, and lower likelihood of being discharged to home or inpatient rehabilitation facility. They had higher in-hospital mortality rate, the difference was however not statistically significant. Conclusion: In conclusion, ischemic stroke affects nearly 25% of patients with RCVS and is associated with an increased rate of other neurologic complications and worse functional outcomes. Patients with traditional cerebrovascular risk factors might have a higher predisposition for developing the ischemic lesions.

scholarly journals SENSITIVITY OF SELF-REPORTED COMORBIDITIES COMPARED TO MEDICARE CLAIMS IN OLDER ADULTS WITH TRAUMATIC BRAIN INJURY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S483-S483
Author(s):  
Aparna Vadlamani ◽  
Jennifer Albrecht
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Medical History ◽  
Acute Injury ◽  
Administrative Claims ◽  
Comorbid Illness ◽  
Medicare Claims ◽  
Patient Reported ◽  
History Of

Abstract Patient reported history of comorbid illness may be the only information available to the treatment team during an acute injury admission. Nevertheless, acute injury, particularly traumatic brain injury (TBI) which affects cognition, may decrease the patient’s ability to accurately report medical history. Thus, the objective of this study was to evaluate the accuracy of patient-reported comorbid illness burden compared to the patient’s Medicare administrative claims. Records of older adults treated for TBI at an urban level 1 trauma center 2006-2010 were linked to their Medicare administrative. Comorbidities were recorded in Medicare claims based on ICD9 codes and were reported in the trauma registry (TR) based on patient medical history recorded by a physician or nurse. Prevalence of each of the following comorbidities was calculated using information from the TR and claims: Alzheimer’s disease and related dementias, chronic kidney disease, COPD, heart failure, diabetes, depression, stroke, and hypertension. Sensitivity of each patient-reported comorbidity was calculated using Medicare claims as the gold standard. We identified patient factors associated with accurate self-report using logistic regression. Among 408 older adults with TBI that linked to their Medicare claims, prevalence of each comorbidity was higher in Medicare claims compared to the TR, except for hypertension. Sensitivity for detecting these comorbidities using the TR ranged from 2% to 68%, with the highest sensitivity observed for hypertension. Older age and race were predictors of less accurate reported medical history. Reconciling self-reported patient history of these comorbidities with those reported in claims can better inform decisions regarding treatment.

scholarly journals Long-Term Outcomes After Reversible Cerebral Vasoconstriction Syndrome

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 670-673 ◽  
Author(s):  
Rosalie Boitet ◽  
Solène de Gaalon ◽  
Claire Duflos ◽  
Grégory Marin ◽  
Jérôme Mawet ◽  
...  
Keyword(s):  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Long Term Outcomes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Follow Up Study ◽  
Cerebral Vasoconstriction ◽  
History Of

Background and Purpose— We aimed to further investigate the long-term outcomes after reversible cerebral vasoconstriction syndrome (RCVS). Methods— A longitudinal follow-up study was conducted in 173 RCVS patients. Results— Of the 172 patients who completed a mean follow-up of 9.2±3.3 years, 10 had a recurrent RCVS that was benign in all. Independent predictors of relapse were having a history of migraine and having exercise as a trigger for thunderclap headache during initial RCVS. After new delivery, the rate of postpartum RCVS was 9%. Conclusions— Overall, long-term outcome after RCVS is excellent.

scholarly journals Transfusion-Related Acute Brain Injury: A Case Report on Reversible Cerebral Vasoconstriction Syndrome

Cureus ◽  
2020 ◽  
Author(s):  
Kevin Yeboah ◽  
Jan Bittar ◽  
Mohammad Almajali ◽  
Momina Soudagar Turkey ◽  
Joanna Ramiro
Keyword(s):  
Case Report ◽  
Brain Injury ◽  
Acute Brain Injury ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction

scholarly journals Iatrogenic acute headache secondary to co-administration of ergometrine and phenylephrine during cesarean section: a case report

2019 ◽  
Author(s):  
Yan Mei Bi ◽  
Juan Ni
Keyword(s):  
Cesarean Section ◽  
Vital Signs ◽  
Severe Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Elective Cesarean Section ◽  
Cerebral Vasoconstriction ◽  
Elective Cesarean ◽  
Acute Headache ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background Reversible cerebral vasoconstriction syndrome has been described as a syndrome of severe recurrent thunderclap headache in bilateral posterior, with or without other neurological symptoms and signs, is fully reversible by 3 months. Vasoconstrictor play an important role in the development of reversible cerebral vasoconstriction syndrome. Case presentation A 37-year-old pregnant women underwent elective cesarean section at 36+6 weeks gestation under combined spinal-epidural anesthesia . After a healthy female neonate was delivered, 0.2mg ergometrine was injected intramuscularly to induce uterine contraction. 30 minutes later, 0.1mg phenylephrine was given intravenously to treatment hypotension. Then she complained of a sudden headache and blood pressure was significantly risen to 163/104 mmHg versus baseline was 118/76 mmHg. Her severe headache was relieved 2 hrs after administering nitroglycerin, and headache did not recur after discontinued nitroglycerin. Conclusion The reason of hypotension should be identified in patients received ergometrine during cesarean section. Phenylephrine or other sympathomimetic should be used cautiously and vital signs should be observed closely for patient who received ergometrine during cesarean section. Nitroglycerin may be an alternative for the treatment of severe headache in reversible cerebral vasoconstriction syndrome.

scholarly journals Reversible cerebral vasoconstriction syndrome promptly diagnosed with magnetic resonance imaging including magnetic resonance angiography during immunosuppressive therapy in a 16-year-old girl with refractory cytopenia of childhood

2016 ◽  
Vol 8 (4) ◽  
Author(s):  
Hideaki Ueki ◽  
Yasushi Sanayama ◽  
Akiyo Miyajima ◽  
Taichiro Tsuchimochi ◽  
Shunji Igarashi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Arteries ◽  
Severe Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Resonance Imaging ◽  
Hematological Disorders ◽  
Cerebral Vasoconstriction ◽  
Ischemic Attack

Reversible cerebral vasoconstriction syndrome (RCVS) is a syndrome characterized by severe headache with segmental vasoconstriction of the cerebral arteries that resolves within 12 weeks. A 16-year-old girl with refractory cytopenia of childhood, who was receiving the immunosuppressant cyclosporine, developed severe headache and was diagnosed with RCVS using magnetic resonance imaging, including magnetic resonance angiography (MRA). MRA is a non-invasive and very effective technique for diagnosing RCVS. MRA should be performed at the onset of severe headache during immunosuppressant administration for children with hematological disorders and may prevent sequelae such as posterior reversible encephalopathy syndrome or ischemic attack.

scholarly journals Reversible Cerebral Vasoconstriction Syndrome: An Important Cause of Acute Severe Headache

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Li Huey Tan ◽  
Oliver Flower
Keyword(s):  
Central Nervous System ◽  
Neurological Complications ◽  
Severe Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Diagnostic Features ◽  
Therapeutic Implications ◽  
Cerebral Vasoconstriction ◽  
Primary Angiitis ◽  
The Central Nervous System ◽  
Acute Headache

Reversible cerebral vasoconstriction syndrome (RCVS) is an increasingly recognized and important cause of acute headache. The majority of these patients develop potentially serious neurological complications. Rigorous investigation is required to exclude other significant differential diagnoses. Differentiating RCVS from subarachnoid haemorrhage (SAH) and primary angiitis of the central nervous system (PACNS) may be difficult but has important therapeutic implications. This paper describes what is currently known about the epidemiology, pathophysiology, clinical, and diagnostic features of the syndrome, an approach to investigation, a summary of treatments, and what is known of prognosis.

Isolated cortical vasogenic edema and hyperintense vessel signs may be early features of reversible cerebral vasoconstriction syndrome: Case reports

Cephalalgia ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 1207-1210 ◽  
Author(s):  
Sho Murase ◽  
Yasufumi Gon ◽  
Akihiro Watanabe ◽  
Kenichi Todo ◽  
Nobuo Kohara ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Symptom Onset ◽  
Vasogenic Edema ◽  
Cerebral Arteries ◽  
Severe Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Resonance Imaging ◽  
Cerebral Vasoconstriction ◽  
Headache Onset

Background The temporal and anatomical features of vasoconstriction in patients with reversible cerebral vasoconstriction syndrome within hours after symptom onset, in the hyperacute phase, are unclear. Case result Herein we report the cases of two patients with acute severe headache who were diagnosed with reversible cerebral vasoconstriction syndrome. Magnetic resonance imaging within hours after symptom onset revealed multiple areas of isolated cortical vasogenic edema and hyperintense vessel signs of the distal cerebral arteries. Follow-up imaging performed four days later in both cases showed diffuse segmental arterial vasoconstriction in the proximal regions of the cerebral arteries. Both patients received antivasoconstrictive therapy shortly after admission, and neither had neurological sequelae at discharge. The magnetic resonance imaging findings improved gradually within three months after symptom onset. Conclusion Isolated cortical vasogenic edema and hyperintense vessel signs, when observed within hours from sudden severe headache onset, may be useful early markers of reversible cerebral vasoconstriction syndrome.

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