scholarly journals Reversible Cerebral Vasoconstriction Syndrome: A Commonly Missed Diagnosis in Acute Severe Headaches

2019 ◽  
Vol 19 (2) ◽  
pp. 154-163
Author(s):  
Siriporn Hirunpat ◽  
Nuttha Sanghan ◽  
Adchara Wan-ai ◽  
Natee Ina ◽  
Pornrujee Hirunpat
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Arteries ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Review Of The Literature ◽  
Common Cause ◽  
Cerebral Vasoconstriction ◽  
Missed Diagnosis

Summary: In spite of the recent acceptance to be a common cause of acute severe headaches, reversible cerebral vasoconstriction syndrome (RCVS) is still commonly missed. The syndrome is characterized by acute severe headaches due to the vasoconstriction of the cerebral arteries, which eventually resolve spontaneously. We present a reported case of RCVS with a typical magnetic resonance angiography (MRA) appearance and a review of the literature.

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.

Reversible Cerebral Vasoconstriction Syndrome

2011 ◽  
Vol 26 (12) ◽  
pp. 1580-1584 ◽  
Author(s):  
Partha S. Ghosh ◽  
A. David Rothner ◽  
Kenneth G. Zahka ◽  
Neil R. Friedman
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Sinus Thrombosis ◽  
Cerebral Arteries ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Diagnostic Dilemma ◽  
Vascular Abnormalities ◽  
Cerebral Vasoconstriction ◽  
Complete Reversal

Reversible cerebral vasoconstriction syndrome is characterized by a reversible segmental and multifocal vasoconstriction of cerebral arteries, and severe headaches with or without focal neurologic deficits or seizures. A 15-year-old boy presented with thunderclap headache. He had severe hypertension, although his neurologic examination was normal. Initial workup for thunderclap headache to exclude subarachnoid or intracranial hemorrhage, meningitis, pituitary apoplexy, or venous sinus thrombosis was negative. Brain magnetic resonance angiography and cerebral angiography demonstrated bilateral anterior and posterior circulation diffuse, multifocal, vascular irregularities (beading and stenosis) suggestive of underlying vasculopathy or vasculitis. He was started on verapamil. There was complete reversal of the vascular abnormalities in 6 weeks evident by magnetic resonance angiography, with resolution of headache and normalization of blood pressure. Reversible cerebral vasoconstriction syndrome has been rarely reported in children. This case report highlights the diagnostic dilemma and management of the rare childhood presentation of this condition.

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.

scholarly journals DIAGNOSTICS OF REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME: CLINICAL MANIFESTATION AND IMAGING PATTERNS

2018 ◽  
pp. 50-55
Author(s):  
E. G. Klocheva ◽  
V. V. Goldobin
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Clinical Manifestation ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Treatment Modification ◽  
Cerebral Vasoconstriction

Data of 130 patients with thunderclap headache are presented. The data include clinical manifestation analysis and neuroimaging results (magnetic resonance angiography). Magnetic resonance angiography was performed 15 days after acute clinical manifestation and permitted to verify cerebral vasoconstriction, that led to treatment modification with clinical and neuroimaging signs of vasoconstriction reverse.

Reversible cerebral vasoconstriction syndrome associated with fingolimod treatment in relapsing–remitting multiple sclerosis three months after childbirth

2015 ◽  
Vol 21 (11) ◽  
pp. 1473-1475 ◽  
Author(s):  
Markus Kraemer ◽  
Ralph Weber ◽  
Michèle Herold ◽  
Peter Berlit
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Conventional Angiography ◽  
Cerebral Vasoconstriction ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute thunderclap headache, evidence of vasoconstriction in conventional angiography or magnetic resonance angiography and reversibility of these phenomena within 12 weeks. Some triggering factors, for example drugs such as selective serotonin reuptake inhibitors, sumatriptan, tacrolimus, cyclophosphamide and cocaine, or states such as pregnancy, puerperium or migraine have been described. We describe the case of a 29-year-old woman with RCVS associated with fingolimod three months after childbirth. This case represents the first report of RCVS in fingolimod treatment.

scholarly journals Clinical significance of centripetal propagation of vasoconstriction in patients with reversible cerebral vasoconstriction syndrome: A retrospective case-control study

Cephalalgia ◽  
2018 ◽  
Vol 38 (12) ◽  
pp. 1864-1875 ◽  
Author(s):  
Masami Shimoda ◽  
Shinri Oda ◽  
Hideaki Shigematsu ◽  
Kaori Hoshikawa ◽  
Masaaki Imai ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Clinical Significance ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Retrospective Case ◽  
Cerebral Vasoconstriction ◽  
Increased Risk ◽  
Before And After ◽  
Control Study

Introduction We previously reported centripetal propagation of vasoconstriction at the time of thunderclap headache remission in patients with reversible cerebral vasoconstriction syndrome. Here we examine the clinical significance of centripetal propagation of vasoconstriction. Methods Participants comprised 48 patients who underwent magnetic resonance angiography within 72 h of reversible cerebral vasoconstriction syndrome onset and within 48 h of thunderclap headache remission. Results In 24 of the 48 patients (50%), centripetal propagation of vasoconstriction occurred on magnetic resonance angiography at the time of thunderclap headache remission. The interval from first to last thunderclap headache in patients with centripetal propagation of vasoconstriction (14 ± 10 days) was significantly longer than that of patients without centripetal propagation of vasoconstriction (4 ± 2 days). In the patients with centripetal propagation of vasoconstriction at the time of thunderclap headache remission, the incidence of another cerebral lesion (38%, 9 of 24 cases) was significantly higher than in patients without centripetal propagation of vasoconstriction (0%). From findings of sequential magnetic resonance angiography before and after thunderclap headache remission, we observed tendencies in which centripetal propagation of vasoconstriction gradually progressed after the onset of reversible cerebral vasoconstriction syndrome and peaked at the time of thunderclap headache remission. The progress of centripetal propagation of vasoconstriction concluded with thunderclap headache remission. Conclusions Centripetal propagation of vasoconstriction has clinical significance as an indicator of the severity of reversible cerebral vasoconstriction syndrome. The presence of centripetal propagation of vasoconstriction is associated with an increased risk of brain lesions and a longer interval from first to last thunderclap headache. Moreover, repeat magnetic resonance angiography to assess centripetal propagation of vasoconstriction during the time from onset to thunderclap headache remission can help diagnose reversible cerebral vasoconstriction syndrome.

Diffuse cerebrovascular dilation: Case report of amezinium metilsulfate-induced reversible cerebral vasoconstriction syndrome

Cephalalgia ◽  
2015 ◽  
Vol 36 (3) ◽  
pp. 289-293 ◽  
Author(s):  
Makoto Kobayashi
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Cerebral Arteries ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Case Description ◽  
Cerebral Vasoconstriction ◽  
Sympathomimetic Drug ◽  
Vasoactive Medications

Background Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches with reversible cerebral vasoconstriction, and often precipitated by the postpartum state and vasoactive medications. We describe a case of a patient with RCVS induced by amezinium metilsulfate, a sympathomimetic drug, in whom magnetic resonance angiography (MRA) initially revealed diffusely dilated cerebral arteries. Case description A 34-year-old woman was prescribed amezinium metilsulfate for hypotension. Twelve days later, she suffered from abrupt severe headaches and was referred to our department. She had no neurological deficits; however, MRA revealed diffusely dilated anterior, middle, and posterior cerebral arteries with vasoconstriction. She was tentatively diagnosed with RCVS and successfully treated with verapamil for headache. Nevertheless, follow-up MRAs disclosed widespread segmental vasoconstriction that resolved in two months. Discussion Diffuse cerebrovascular dilation has not been addressed but may be associated with RCVS pathophysiology. In addition, physicians should bear in mind that amezinium metilsulfate can potentially induce RCVS.

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.

Reversible cerebral vasoconstriction syndrome precipitated by airplane descent: Case report

Cephalalgia ◽  
2016 ◽  
Vol 37 (11) ◽  
pp. 1102-1105 ◽  
Author(s):  
Akiyuki Hiraga ◽  
Yuya Aotsuka ◽  
Kyosuke Koide ◽  
Satoshi Kuwabara
Keyword(s):  
Case Report ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Time Course ◽  
Air Travel ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Precipitating Factors ◽  
Vasoactive Agents ◽  
Cerebral Vasoconstriction

Background Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by segmental vasospasm. Vasoactive agents and childbirth have been reported as precipitating factors for RCVS; however, RCVS induced by altitude change or air travel has rarely been reported. Case We present a case of a 74-year-old woman who presented with thunderclap headache during airplane descent. Magnetic resonance angiography demonstrated segmental vasoconstriction that improved 9 days after onset. Conclusion These findings indicate that airplane descent may be a trigger of RCVS. The time course of headache in the present case was similar to that of prolonged headache attributed to airplane travel, indicating that RCVS during air travel may have previously been overlooked and that some headache attributed to airplane travel cases may represent a milder form of RCVS.

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