scholarly journals Could the Use of Antihistamines Have Triggered Reversible Cerebral Vasoconstriction Syndrome? A Case Report

2021 ◽  
pp. 50-57
Author(s):  
Sara Assadi ◽  
Latif Rahman ◽  
Mark Kong ◽  
Sukaina Asad
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Brain Imaging ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Magnetic Resonance Angiogram ◽  
Medication History ◽  
Acute Setting ◽  
Cerebral Vasoconstriction ◽  
Ct Brain

A 38-year-old woman presented to the emergency department with recurrent severe headaches. Although initial computer tomography (CT) brain imaging was unremarkable, a later CT venogram demonstrated a small subarachnoid haemorrhage. Magnetic resonance angiogram (MRA) brain imaging subsequently confirmed reversible cerebral vasoconstriction syndrome (RCVS). In the acute setting, RCVS rarely falls into a differential diagnosis for headache presentations, as in this case. The radiological variability can make diagnosis of RCVS challenging. However, there are clinical consistencies that can aid physicians into accurately diagnosing RCVS. A thorough history, including a medication history, can help identify potential triggers of RCVS. As in this case, the combination of commonly used drugs, including antihistamines, provides a plausible trigger for RCVS. The direct vasoactive role of antihistamines is unclear, yet there is suggestion for its ability to potentiate the vasoactive action of other drugs. In this case we propose a causal relationship between the use of antihistamine and the development of RCVS.

Reversible cerebral vasoconstriction syndrome secondary to caffeine withdrawal

2017 ◽  
Vol 63 (1) ◽  
pp. 22-24 ◽  
Author(s):  
Dheeraj Kalladka ◽  
Aslam Siddiqui ◽  
Alok Tyagi ◽  
Edward Newman
Keyword(s):  
Magnetic Resonance ◽  
Hospital Admission ◽  
Brain Imaging ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasculature ◽  
Magnetic Resonance Angiogram ◽  
Cerebral Vasoconstriction ◽  
Caffeine Withdrawal ◽  
Magnetic Resonance Brain Imaging

We describe a 39-year-old man who developed thunderclap headaches during a hospital admission for accidental superficial burns. His magnetic resonance brain imaging was normal expect for diffuse segmental vasoconstriction. Prior to admission, he was consuming excessive amounts of caffeine which was restarted and slowly tapered and stopped over weeks. Repeat magnetic resonance angiogram showed resolution of segmental vasoconstriction. The implications of prescribed and non-prescribed drugs on cerebral vasculature have been discussed.

scholarly journals The Need for a Rational Approach to Vasoconstrictive Syndromes: Transcranial Doppler and Calcium Channel Blockade in Reversible Cerebral Vasoconstriction Syndrome

2016 ◽  
Vol 8 (2) ◽  
pp. 161-171 ◽  
Author(s):  
Elisabeth B. Marsh ◽  
Wendy C. Ziai ◽  
Rafael H. Llinas
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Transcranial Doppler ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Rational Approach ◽  
Channel Blockers ◽  
Channel Blockade ◽  
Calcium Channel Blockade ◽  
Acute Setting ◽  
Cerebral Vasoconstriction

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) typically affects young patients and left untreated can result in hemorrhage or ischemic stroke. Though the disorder has been well characterized in the literature, the most appropriate way to diagnose, treat, and evaluate therapeutic response remains unclear. In previous studies, transcranial Doppler ultrasound (TCD) has shown elevated velocities indicative of vasospasm. This imaging modality is noninvasive and inexpensive; an attractive option for diagnosis and therapeutic monitoring if it is sensitive enough to detect changes in the acute setting given that RCVS often affects the distal vessels early in the course of disease. There is also limited data that calcium channel blockade may be effective in treating vasospasm secondary to RCVS, though the agent of choice, formulation, and dose are unclear. Methods: We report a small cohort of seven patients presenting with thunderclap headache whose vascular imaging was consistent with RCVS. All were treated with calcium channel blockade and monitored with TCD performed every 1–2 days. Results: On presentation, TCD correlated with standard neuroimaging findings of vasospasm (on MR, CT, and conventional angiography). TCD was also able to detect improvement in velocities in the acute setting that correlated well with initiation of calcium channel blockade. Long-acting verapamil appeared to have the greatest effect on velocities compared to nimodipine and shorter-acting calcium channel blockers. Conclusion: Though small, our cohort demonstrates potential utility of TCD to monitor RCVS, and relative superiority of extended-release verapamil over other calcium channel blockers, illustrating the need for larger randomized trials.

Isoflavones and gastrointestinal infection: Two potential triggers for reversible cerebral vasoconstriction syndrome

Cephalalgia ◽  
2017 ◽  
Vol 38 (5) ◽  
pp. 984-987 ◽  
Author(s):  
Björn Machner ◽  
Tobias Boppel ◽  
Thomas Münte
Keyword(s):  
Differential Diagnosis ◽  
Post Partum ◽  
Cerebral Arteries ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Gastrointestinal Infection ◽  
Cerebral Vasoconstriction ◽  
Vasoactive Substances ◽  
Important Differential Diagnosis ◽  
Estrogenic Potential

Background Reversible cerebral vasoconstriction syndrome (RCVS) is an important differential diagnosis of singular or recurrent thunderclap headache. Prognosis is generally good, however complications of the transient segmental vasospasms of cerebral arteries such as stroke, subarachnoidal hemorrhage and brain edema may worsen the clinical outcome. Although the exact pathomechanism is still unclear, various vasoactive substances and conditions (e.g. post partum) have been identified as triggering RCVS. Cases We report on the clinical course and management of two cases of typical RCVS that were associated with two different precipitants previously not described: A gastrointestinal infection and isoflavones, which are phytoestrogens used for menopausal vasomotor symptoms. Discussion In the case of gastrointestinal infection, either systemic inflammatory processes might lead to disturbances of vascular tone, or the repetitive vomiting that resembles Valsalva manoeuvers known to trigger RCVS. In the case of isoflavone intake, it may be their estrogenic potential that induces dysregulation of cerebral arteries, a mechanism known from other states of hormonal change such as post-partum angiopathy. However, the association of both precipitating factors with RCVS in our two cases is not a proof for a causal relationship, and there may have been additional potential triggers for RCVS. Conclusion In patients with (gastrointestinal) infection and concomitant thunderclap headache, RCVS should be considered as an important differential diagnosis due to its major complications. Since RCVS may be triggered by various vasoactive substances, taking the medical history should always include over-the-counter drugs and dietary supplements (such as the isoflavones) beside the regular medication.

scholarly journals On the role of quantitative brain imaging in the differential diagnosis of speech disorders

2002 ◽  
Vol 56 (1) ◽  
pp. 111-115 ◽  
Author(s):  
Ludger H. Tebartz Van Elst ◽  
Freimut D Juengling ◽  
Jan Kassubek ◽  
Klaus Schmidtke ◽  
Thorsten Thiel ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Brain Imaging ◽  
Speech Disorders

scholarly journals PET CT Brain for the Differential Diagnosis of Dementia -Indian Case Reports

2020 ◽  
Vol 14 (1) ◽  
pp. 68-73
Author(s):  
Aman Gupta ◽  
Aashish Gambhir
Keyword(s):  
Differential Diagnosis ◽  
Case Reports ◽  
Memory Loss ◽  
Current Case ◽  
Pet Ct ◽  
Diagnosis Of Dementia ◽  
Control Of Diabetes ◽  
Ct Brain ◽  
Differential Diagnosis Of Dementia

India has been termed as Diabetic hub of the globe. Along with other complications, one of the underestimated complication is cognitive decline and memory loss associated with poor diabetes control. In the Indian context, structural imaging like MRI-Magnetic Resonance imaging is more commonly used in Neurological disorders such as stroke, head injury, Functional imaging of the human brain has been underutilized in the Indian scenario. One such technique is PET CT which has been typically used as a cancer biomarker in India. By virtue of current case study, we propose i) association between poor control of Diabetes and poor cognition ii) role of PET CT brain in differential diagnosis of Dementia. We present two case reports providing strong findings for utilization of PET CT brain in Dementia protocols.

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.

Reversible cerebral vasoconstriction syndrome in two patients with a carotid glomus tumour

Cephalalgia ◽  
2010 ◽  
Vol 30 (10) ◽  
pp. 1271-1275 ◽  
Author(s):  
Benjamin Verillaud ◽  
Anne Ducros ◽  
Hélène Massiou ◽  
Patrice Tran Ba Huy ◽  
Marie-Germaine Bousser ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Arteries ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Glomus Tumour ◽  
Resonance Imaging ◽  
Magnetic Resonance Angiogram ◽  
Cerebral Magnetic Resonance Imaging ◽  
Cervical Mass ◽  
Cerebral Vasoconstriction ◽  
Rule Out

We report two patients with reversible cerebral vasoconstriction syndrome (RCVS) and carotid glomus tumour. The first patient presented with multiple thunderclap headaches. Cervical and cerebral magnetic resonance imaging showed diffuse cerebral vasoconstriction on magnetic resonance angiogram (MRA) and a carotid glomus tumour. The second patient presented with a cervical mass and was diagnosed with a non-secreting paraganglioma of the carotid body. Surgery with pre-operative angiography was followed by thunderclap headaches and MRA showed segmental cerebral vasoconstriction. Both patients were treated with nimodipine and headaches stopped. Both had normal cerebral arteries on the control MRA at 3 months. These two cases suggest that a paraganglioma may increase the susceptibility to develop RCVS. As a consequence, patients with RCVS should be investigated for a carotid glomus tumour, and patients with paraganglioma reporting severe headaches should have a cerebral MRA in order to rule out cerebral vasoconstriction.

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