scholarly journals Acute Headache at Emergency Department: Reversible Cerebral Vasoconstriction Syndrome Complicated by Subarachnoid Haemorrhage and Cerebral Infarction

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
M. Yger ◽  
C. Zavanone ◽  
L. Abdennour ◽  
W. Koubaa ◽  
F. Clarençon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Subarachnoid Haemorrhage ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Occipital Lobe ◽  
Haemorrhagic Stroke ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction ◽  
The Right ◽  
The Brain

Introduction.Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH) and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome.Case Report.A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache.Conclusion.Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that reversible cerebral vasoconstriction syndrome is still underrecognized, in particular in general emergency departments.

Pediatric Reversible Cerebral Vasoconstriction Syndrome: Two Unique Cases with a Review of all Reported Children

2021 ◽  
Author(s):  
Neelu Desai ◽  
Rahul Badheka ◽  
Nitin Shah ◽  
Vrajesh Udani
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Cerebral Vasoconstriction ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Mr Angiogram

AbstractReversible cerebral vasoconstriction syndrome (RCVS) has been well described in adults, but pediatric cases are yet under recognized. We describe two children with RCVS and review similar already published pediatric cases. The first patient was a 10-year-old girl who presented with severe headaches and seizures 3 days after blood transfusion. Brain magnetic resonance imaging (MRI) showed changes compatible with posterior reversible encephalopathy syndrome and subarachnoid hemorrhage. Magnetic resonance angiogram showed diffuse vasoconstriction of multiple cerebral arteries. The second patient was a 9-year-old boy who presented with severe thunderclap headaches. Brain MRI showed isolated intraventricular hemorrhage. Computed tomography/MR angiogram and digital subtraction angiogram were normal. A week later, he developed focal neurological deficits. Repeated MR angiogram showed diffuse vasospasm of multiple intracranial arteries. Both children recovered completely. A clinico-radiological review of previously reported childhood RCVS is provided.

Reversible Cerebral Vasoconstriction Syndrome with Posterior Leucoencephalopathy after Oral Contraceptive Pills

Cephalalgia ◽  
2009 ◽  
Vol 30 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Y Soo ◽  
AB Singhal ◽  
T Leung ◽  
S Yu ◽  
H Mak ◽  
...  
Keyword(s):  
Oral Contraceptive ◽  
Cerebral Arteries ◽  
Haemorrhagic Stroke ◽  
Sudden Onset ◽  
Reproductive Hormones ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Oral Contraceptive Pills ◽  
Cerebral Vasoconstriction ◽  
Contraceptive Pills

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset recurrent ‘thunderclap’ headaches with reversible multifocal narrowing of the cerebral arteries, often associated with focal neurological deficits from ischaemic or haemorrhagic stroke. It has been associated with exposure to vasoconstrictive drugs, pregnancy, migraine, and a variety of other conditions. Whereas the pathophysiology of RCVS remains unclear, changes in the levels of female hormones are considered important because RCVS predominantly affects women and is frequently associated with pregnancy. We report a patient with angiographically confirmed RCVS whose MRI showed reversible brain oedema, suggesting an overlap between RCVS and the reversible posterior leucoencephalopathy syndrome. The only identified risk factor was oral contraceptive pills started 1 month prior to onset, supporting a role for female reproductive hormones in precipitating this overlap syndrome.

093 Clinical and imaging discordance in reversible cerebral vasoconstriction syndrome

2018 ◽  
Vol 89 (6) ◽  
pp. A37.2-A37 ◽  
Author(s):  
Michael J Devlin ◽  
Archana Dwivedee ◽  
Richard P White
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Cerebral Arteries ◽  
Clinical Status ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Clinical State ◽  
Cerebral Vasoconstriction ◽  
Csf Analysis ◽  
Elevated Protein ◽  
Digital Subtraction Angiogram ◽  
Reversible Encephalopathy

IntroductionReversible cerebral vasoconstriction syndrome (RCVS) is to be suspected in cases of thunderclap headache particularly when associated with convex subarachnoid haemorrhage without cerebral aneurysm. Angiographic changes and clinical state do not always correlate. We present a case report from the Townsville Hospital.CaseA 49 year old female presented to another hospital with recurrent thunderclap headaches first commencing with exercise. The medical history included idiopathic intracranial hypertension in remission, chronic migraine treated with botulinum toxin, and depression treated with amitriptyline and desvenlafaxine. MR imaging revealed cerebral vertex subarachnoid haemorrhage with normal MR angiogram of the cerebral vessels. The patient was transferred to our institution in a confused and restless state for cerebral digital subtraction angiogram, which was normal. A lumbar puncture revealed elevated white cells of 17×106/L with normal CSF protein and opening pressure of 39 cm H2O. Nimodipine that had been commenced before the patient became encephalopathic was ceased. Her confusion and headaches resolved but relapsed after three days. A repeat MR brain revealed multiple T2 hyperintensities in bilateral anterior and posterior circulation territories demonstrating diffusion restriction, and MR angiography revealed new segmental strictures and beading of bilateral middle and anterior cerebral arteries. The patient was diagnosed with overlap RCVS/posterior reversible encephalopathy syndrome; desvenlafaxine was ceased, acetazolamide commenced for raised intracranial pressure and a several week course of nimodipine recommenced. The patient was discharged home after resolution of headache and confusion without neurological deficit.ConclusionThis case highlights the dynamic changes of vasoconstriction and that angiographic findings can be discordant from the clinical status. Serial imaging is required to detect abnormalities of RCVS when the clinical suspicion is high. CSF analysis can be normal, however may reveal elevated protein or pleocytosis. The cause of our patient’s RCVS was thought to be the chronic use of desvenlafaxine.

scholarly journals Reversible cerebral vasoconstriction syndrome with cerebral infarction caused by acute high-level vapor exposure of ethylene oxide: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bin Lin ◽  
Chao Wang ◽  
Nan Lu ◽  
Le Zhang ◽  
Biao Jiang
Keyword(s):  
Ethylene Oxide ◽  
Cerebral Infarction ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Case Presentation ◽  
Cerebral Vasoconstriction ◽  
Capsule Production ◽  
High Level

Abstract Background With the increasing production and use of ethylene oxide (EO) worldwide, its explicit bio-toxicity has drawn more and more attention. At present, most studies focus on chronic EO exposure. Studies on acute EO exposure are rare, especially with imaging studies. To our knowledge, this work is the first documented case of reversible cerebral vasoconstriction syndrome (RCVS) with cerebral infarction caused by EO. Case presentation A 58-year-old woman who worked in a capsule production factory got an unprotected acute EO inhalation due to accidental exposure to sterilization gas. She suffered from nausea, vomiting, and severe paroxysmal headaches, but the first brain MRI scan of the patient showed no significant abnormality. Nine days after inhalation, she developed recurrent thunderclap headaches and gradual complete blindness. The follow-up brain MRI, 12 days after inhalation, demonstrated extensive cytotoxic edema. Fifteen days and 21 days after EO (ethylene oxide) inhalation, head MRA and CTA respectively showed diffuse vasoconstriction of cerebral arteries. Fifty-nine days after EO inhalation, head MRA assessed reversibility of the vasoconstriction. According to clinical features and imaging findings, RCVS with cerebral infarction can be diagnosed. The patient was sensitive to light and light reflection but still blind after symptomatic and rehabilitation therapy. Conclusions We report an acute EO exposure case in which the patient suffered from RCVS with cerebral infarction, which previous literature has not reported. This article aimed to raise awareness of encephalopathy after EO acute exposure.

scholarly journals A Case of Reversible Cerebral Vasoconstriction Syndrome: Postpartum Cerebral Angiopathy in a 32-Year-Old Primigravid Treated with Intravenous Immunoglobulin

2021 ◽  
pp. 620-627
Author(s):  
John Angelo Luigi S. Perez ◽  
Manilen E. Dueñas ◽  
Senna S. Lim ◽  
Geraldine Siena L. Mariano ◽  
Jose C. Navarro
Keyword(s):  
Intravenous Immunoglobulin ◽  
Occipital Lobe ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction ◽  
Cranial Mri ◽  
Left Thalamus ◽  
Postpartum Cerebral Angiopathy ◽  
Gcs Score ◽  
The Right ◽  
Cerebral Angiopathy

This is a case of a 32-year-old primigravid who developed sudden severe headache on the 7th day postpartum associated with focal neurologic deficits and altered sensorium. She had a GCS score of 6, anisocoric pupils and an NIHSS score of 31. Cranial MRI with MRA showed multifocal hyperacute to acute infarcts on the left occipital lobe, left thalamus, and midbrain which was more prominent on the right. Due to clinical deterioration, a repeat Cranial MRI with MRA was done and showed progression of infarcts involving both thalami and right pons with interval appearance of contour irregularities in the proximal anterior cerebral, posterior cerebral, basilar and internal carotid arteries. Serial transcranial Doppler showed significant distal right middle cerebral artery vasospasm. She was managed as a case of reversible cerebral vasoconstriction syndrome, associated with postpartum cerebral angiopathy. Intravenous pulse methylprednisolone was started subsequently IVIG was initiated. Intravenous immunoglobulin was given for 5 days. The patient gradually improved, underwent rehabilitation therapy, and was discharged stable after 6 weeks.

scholarly journals Critical care of subarachnoid haemorrhage

2017 ◽  
Vol 04 (04) ◽  
pp. S49-S55
Author(s):  
Michael Souter
Keyword(s):  
Critical Care ◽  
Subarachnoid Haemorrhage ◽  
Neurological Outcome ◽  
Neurocritical Care ◽  
Comprehensive Evaluation ◽  
Haemorrhagic Stroke ◽  
Care Team ◽  
Evidence Based ◽  
New Treatment ◽  
The Brain

AbstractSubarachnoid haemorrhage (SAH) is a consistent presentation of haemorrhagic stroke of significance to clinicians in neurocritical care, inducing consequent effects on non-neurological systems, while at the same time, rendering the brain vulnerable to secondary physiological insult modifying neurological outcome, despite control of the original point of haemorrhage. Coordinated treatment depends on comprehensive evaluation of both cerebral and systemic physiology, identifying and treating impaired function. The presence of a dedicated neurocritical care team can benefit outcome. Protocols of care have evolved to meet evidence-based challenges, discarding potentially deleterious components of hypervolaemia and haemodilution, while maintaining pressure-guided perfusion. Treatment targets have also evolved with a shift in focus away from SAH-associated vasospasm, towards actual ischaemic outcome – illustrated by lack of effectiveness of pharmaceutical treatments of vasospasm. Clinicians must consequently review pathophysiological mechanisms of injury and devise new treatment opportunities.

scholarly journals Lessons Learned from a Fulminant Case of Reversible Cerebral Vasoconstriction Syndrome: Past Medical History Misleads the Diagnosis and Intra-Arterial Milrinone Offers Diagnostic Utility

2021 ◽  
Vol 16 (1) ◽  
pp. 78-82
Author(s):  
Paul J Alapatt ◽  
Ajay Panwar ◽  
Gigy Varkey Kuruttukulam ◽  
Kaushik Sundar
Keyword(s):  
Post Partum ◽  
Cerebral Arteries ◽  
Pulse Therapy ◽  
Computed Tomographic Angiography ◽  
Lessons Learned ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Diagnostic Utility ◽  
Computed Tomographic ◽  
Cerebral Vasoconstriction ◽  
Seizure Episode

A 34-year-old post-partum female having dermatomyositis developed headache and became comatose after a seizure episode. Magnetic resonance imaging of brain showed a massive left ganglio-capsular bleed for which decompressive surgery was done. Computed tomographic angiography showed multiple foci of narrowing and irregularities in distal cerebral vessels. In view of dermatomyositis, the diagnosis of vasculitis was considered and pulse therapy of intravenous methylprednisolone was started. The patient, however, showed no improvement and developed new brain infarcts. She was subsequently taken up for a diagnostic cerebral angiography which showed multifocal severe narrowing in bilateral major cerebral arteries. These angiographic abnormalities showed excellent reversibility to intra-arterial milrinone and hence, reversible cerebral vasoconstriction syndrome (RCVS) was diagnosed. Normal angiographic findings in the first week do not rule out the disease and a repeat angiography should be considered if the clinical suspicion of the RCVS is high. Intra-arterial milrinone has a high diagnostic utility.

scholarly journals Average dimensions of the vessels at the base of the brain and the embryological basis of its variations

2013 ◽  
Vol 02 (04) ◽  
pp. 180-189
Author(s):  
Iqbal S.
Keyword(s):  
Anterior Part ◽  
Cerebral Arteries ◽  
Cerebral Dominance ◽  
Circle Of Willis ◽  
Detailed Knowledge ◽  
Differential Growth ◽  
Ischemic Attack ◽  
The Individual ◽  
The Right ◽  
The Brain

Abstract Background and aims: The cerebral circulation is constantly maintained by the anastomotic circle of Willis which is often anomalous in more than 50% of the normal adult brains. These anomalies increase the risk of the stroke and transient ischemic attack in older patients. Adequate blood flow through the circle of Willis is often necessary to prevent these ischemic infarctions. The anomalies of cerebral vessels are directly related to the differential growth of various parts of the brain. A detailed knowledge of the individual measurements of the cerebral arteries is useful to neurosurgeon in planning the shunt operations and in the choice of their patients. The present study is aimed to analyze the average dimensions of the vessels at the base of brain and an attempt to explain the common form of variations in terms of embryological development. Materials and methods: Fifty adult cadaveric brains were obtained from routine cadaveric dissections. The base of the brain with the circle of Willis was fixed in 10% formalin and preserved. The circle was analyzed for variations in the size, length and number of the component vessels and any asymmetry in the configuration. The dimensions of the vessels forming the circle were measured using graduated calipers. The observations were recorded and tabulated. Results: Asymmetry was observed in 10% to 36% of the circles in this study. Anomalies were more common in the posterior than in the anterior part of the circle. The posterior anomalies included hypoplastic vessels, absent vessels and embryonic derivation while anterior anomalies were predominantly of accessory vessels. Middle cerebral artery exhibited the least variations. In majority of the circles, left sided vessels were larger in diameter than the right. Conclusions: Variations are more common in the posterior than in the anterior part of the circle and on the right than on the left side of the brain. There was no correlation between the variations of circle of Willis of the right side and the left cerebral dominance. There seems to be no difference between races, concerning the anatomic variations of the brain circulation.

scholarly journals Prevalence of non-contrast CT abnormalities in adults with reversible cerebral vasoconstriction syndrome: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e041776
Author(s):  
Ryan Daniel Gotesman ◽  
Naomi Niznick ◽  
Brian Dewar ◽  
Dean A Fergusson ◽  
Risa Shorr ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cerebral Arteries ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Vascular Lesions ◽  
Primary Data ◽  
Cochrane Library ◽  
Cerebral Vasoconstriction ◽  
Contrast Ct ◽  
The Impact

IntroductionReversible cerebral vasoconstriction syndrome (RCVS) is characterised by severe, recurrent thunderclap headaches (TCHs) and vasoconstriction of cerebral arteries that resolve within 3 months. Abnormalities on non-contrast CT (NCCT) such as ischaemic strokes, intracerebral haemorrhage and subarachnoid haemorrhages are frequently observed on brain imaging of patients with RCVS though their prevalence varies considerably between studies. The aim of this systematic review and meta-analysis is to estimate the prevalence of NCCT abnormalities seen on neuroimaging of adult patients with RCVS.Methods and analysisWe will search the Medline, Embase and the Cochrane Library databases for studies on the prevalence of NCCT abnormalities on neuroimaging of patients with RCVS. Search results will be screened for eligibility by title and abstract. Suitable studies will be fully reviewed and relevant data extracted using a data abstraction form. The studies will be assessed for methodological quality, risk of bias and heterogeneity. Prevalence estimates across studies will be pooled using a random-effects model and subgroup analysis will be performed to assess the impact of age, sex, publication year and study design on prevalence of vascular lesions. Sensitivity analysis will be used to investigate the robustness of the findings. This protocol has been devised using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist.Ethics and disseminationFormal ethics is not required as primary data will not be collected. The findings of this study will be disseminated through a peer-reviewed publication and conference presentations.Trial registration numberCRD42020190637.

First and Second Language Patterns of Brain Activation in Korean Layrngeal Contrasts

2008 ◽  
Vol 14 ◽  
pp. 1-19 ◽  
Author(s):  
Haeil Park ◽  
Gregory Iverson
Keyword(s):  
Second Language ◽  
Native Speakers ◽  
Occipital Lobe ◽  
Brain Regions ◽  
Second Language Speakers ◽  
Significant Difference ◽  
Native Speakers Of English ◽  
Specific Activities ◽  
The Right ◽  
The Brain

Abstract. This study aims to localize the brain regions involved in the apprehension of Korean laryngeal contrasts and to investigate whether the Internal Model advanced by Callan et al. (2004) extends to first versus second language perception of these unique three-way laryngeal distinctions. The results show that there is a significant difference in activation between native and second-language speakers, consistent with the findings of Callan et al. Specific activities unique to younger native speakers of Korean relative to native speakers of English were seen in the cuneus (occipital lobe) and the right middle frontal gyrus (Brodmann Area [BA] 10), areas of the brain associated with pitch perception. The current findings uphold Silva's (2006) conclusion that the laryngeal contrasts of Korean are increasingly distinguished less by VOT differences than by their effect on pitch in the following vowel. A subsequent experiment was conducted to establish whether more traditional, older native speakers of Korean who still make clear VOT distinctions also activate both the cuneus and BA 10 in the same task. Preliminary results indicate that they do not, whereas speakers with overlapping VOT distinctions do show intersecting activations in these areas, thus corroborating Silva's claim of emergent pitch sensitivity in the Korean laryngeal system.

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