scholarly journals Hemorrhagic Reversible Cerebral Vasoconstriction Syndrome: Clinical Presentation, Differential Diagnosis, Mechanism, and Treatment

2021 ◽  
Vol 4 (1) ◽  
pp. 42-46
Author(s):  
Se-Heum Park ◽  
Sang-Hoon Lee ◽  
Kyung-Jae Park ◽  
Shin-Hyuk Kang ◽  
Dong-Hyuk Park
Keyword(s):  
Differential Diagnosis ◽  
Clinical Presentation ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction

Thunderclap Headache

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction ◽  
Vasoactive Medication ◽  
Angiographic Findings

Reversible cerebral vasoconstriction syndrome can cause thunderclap headache, subarachnoid hemorrhage, and stroke. The clinical presentation can be similar to aneurysmal subarachnoid hemorrhage and therefore requires rapid angiography. Angiographic findings of vasculopathy and resolution of clinical symptoms and imaging abnormalities support this diagnosis. This syndrome is most often incited following pregnancy or the ingestion of a vasoactive medication.

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 Postpartum Reversible Cerebral Vasoconstriction Syndrome Presenting with Radiological Plethora

2021 ◽  
Author(s):  
Manisha Sharma ◽  
Bindu Menon ◽  
Gayatri Manam
Keyword(s):  
Clinical Presentation ◽  
Cerebral Arteries ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Radiological Findings ◽  
Radiological Features ◽  
Cerebral Vasoconstriction ◽  
Atypical Clinical Presentation ◽  
Ischemic Attack ◽  
High Index Of Suspicion ◽  
Reversible Encephalopathy

AbstractReversible cerebral vasoconstriction syndrome (RCVS) is a clinicoradiological syndrome characterized by segmental vasoconstriction of cerebral arteries with resolution in most patients within 1 to 3 months. It has been known to be a benign uniphasic reversible illness but cases of fulminant RCVS with mortality have also been reported. The symptoms can be varied with presentations like transient ischemic attack (TIA), ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and posterior reversible encephalopathy syndrome (PRES). We report a postpartum female with RCVS with radiological features of ICH, SAH, atypical PRES, and atypical clinical presentation as well. RCVS can be frequently missed unless there is a high index of suspicion. Hence clinicians should be aware of the typical and the atypical presentation of RCVS along with the radiological findings with the potential complications. Early suspicion and detection in the emergency help in recovery and reducing morbidity.

scholarly journals Reversible cerebral vasoconstriction syndrome: the importance of follow-up imaging within 2 weeks

2020 ◽  
Author(s):  
Kiyomitsu Fukaguchi ◽  
Tadahiro Goto ◽  
Hiroyuki Fukui ◽  
Ichiro Sekine ◽  
Hiroshi Yamagami
Keyword(s):  
Differential Diagnosis ◽  
Treatment Strategies ◽  
Primary Headache ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
High Systolic Blood Pressure ◽  
Cerebral Vasoconstriction ◽  
Ct Findings ◽  
History Of

Abstract Background: In patients with thunderclap headache, reversible cerebral vasoconstriction syndrome (RCVS) should be considered as a differential diagnosis. However, RCVS diagnosis in the emergency department (ED) remains challenging. This study described the clinical features of RCVS, determined the factors related to RCVS diagnosis, and suggested treatment strategies for its management. Methods: We retrospectively identified eight patients diagnosed with RCVS and reviewed their medical records. From January 2010 to March 2019, eight patients with RCVS (ages 18-69 years, 5 females) were identified. Results: The median duration from the ED visit to RCVS diagnosis was 6 days (range, 1-11 days). Of the eight patients, seven were middle-aged, six had apparent triggers, six had subarachnoid haemorrhage (SAH), five had high systolic blood pressure, and none had any specific abnormality observed upon physical examination. At the ED visit, RCVS was diagnosed in only one patient with a history of RCVS. In other patients, SAH was diagnosed in two patients, and primary headache was diagnosed in four patients with negative computed tomography (CT) findings. Based on the follow-up imaging, seven of eight patients with convexal SAH were diagnosed as having RCVS (as the cause of SAH) using angiography (e.g., magnetic resonance angiography). Conclusions: RCVS with negative CT findings at the ED visit was likely to be misdiagnosed as primary headache. In patients with thunderclap headache and negative CT findings, physicians should consider RCVS as a differential diagnosis, inform patients of the risk of RCVS and the likelihood of a negative image evaluation early in the course of the disease, and carry out follow-up imaging within 2-weeks of the visit.

Abstract TP228: The Overlap of Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Meghan Purohit ◽  
Monica Scarsella ◽  
Naresh Mullaguri ◽  
Dinesh Jillella ◽  
Dolora Wisco ◽  
...  
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Presentation ◽  
Arterial Stenosis ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Imaging Findings ◽  
Inclusion Criteria ◽  
Posterior Reversible Encephalopathy ◽  
Cerebral Vasoconstriction ◽  
Tertiary Center ◽  
Reversible Encephalopathy

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome with typical neuroimaging findings of vasogenic cerebral edema in posterior brain regions. Reversible cerebral vasoconstriction syndrome (RCVS) is diagnosed when there is reversible cerebral vessel narrowing and often with thunderclap headache. The two diseases have overlap in clinical and radiographic features. Objective: To compare clinical presentation, vascular abnormalities and imaging findings among PRES and RCVS. Methods: We searched patients in electronic health record at a single tertiary center from January 2008 to December 2018. Inclusion criteria was 18 years or older with clinical and radiographic evidence of PRES or RCVS. PRES was diagnosed by clinical presentation and presence of vasogenic edema on radiographic imaging. RCVS was determined by clinical presentation and transient arterial stenosis. Patient demographics, presenting symptoms, comorbid conditions, and imaging findings were compared between PRES and RCVS populations. Analysis was performed using Fisher’s exact test Results: Seventy-four patients with PRES and 24 patients with RCVS met inclusion criteria. The median age and presenting blood pressure did not differ between PRES and RCVS groups. PRES population consisted of fewer females (70%) compared to RCVS (92%, p=0.05). There was no significant difference in frequency of DWI lesions in PRES (37%) and RCVS (24%, p=0.308). Among patients who had arterial imaging, arterial stenosis was seen in 28% (13/46) of PRES. The occurrence of > 50% FLAIR reversibility was more common in PRES (67%) and seen less frequently in RCVS (27%, p=0.008). Conclusion: There is radiographic overlap between PRES and RCVS. About a quarter of PRES have arterial stenosis, while about a quarter of the RCVS group had FLAIR reversibility.

scholarly journals A Case of Thunderclap Headache during Pregnancy

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Caroline Peyronnard MD ◽  
Elizabeth Leroux MD ◽  
Mehdi Gaha MD
Keyword(s):  
Differential Diagnosis ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Secondary Process ◽  
Primary Headaches ◽  
Cerebral Vasoconstriction ◽  
Migrainous Patient ◽  
Starting Point ◽  
Life Threatening ◽  
New Onset

Headache during pregnancy is a common issue for which there is a broad differential diagnosis, ranging from common benign primary headaches to certain life-threatening conditions. Although it can be a challenging diagnosis, the presence of previously unknown or new-onset headaches can alert the clinician to the possibility of an underlying secondary process, and orient the subsequent investigation.Here, we present the case of a 33-year-old migrainous patient presenting in her 36th week of pregnancy with recurrent thunderclap headaches (TCH) in association with multifocal cerebral arterial vasospasms, compatible with a diagnosis of reversible cerebral vasoconstriction syndrome. This case serves as a starting point to briefly discuss this syndrome, its particularities during pregnancy, and its management before reviewing some other important entities that can present with TCH during pregnancy. This case also underscores the paramount importance of identifying the presence of a different pattern of headaches in a patient consulting for this symptom, in order to plan further investigation.

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.

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