scholarly journals Reversible Cerebral Vasoconstriction Syndrome: an important cause of thunderclap headache

2014 ◽  
Vol 13 (2) ◽  
pp. 74-76
Author(s):  
Emily Montague ◽  
◽  
Christopher Murphy ◽  
Keyword(s):  
Cerebral Angiography ◽  
Cerebral Arteries ◽  
Severe Headache ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction

Reversible cerebral vasoconstriction syndrome (rCVS) is an important cause of acute severe headache that is poorly understood and under-recognised. It typically presents with recurrent thunderclap headaches and is characterised by multifocal, segmental constriction and dilatation of the cerebral arteries, shown by a ‘string of beads’ appearance, on cerebral angiography. We describe a case of rCVS in a 39-year-old male presenting with post-coital thunderclap headaches following a whiplash-type injury.

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 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.

scholarly journals Case Report: Reversible Cerebral Vasoconstriction Syndrome in a cancer patient using ZoladexTM

2021 ◽  
Author(s):  
Paolla Giovanna Rossito de Magalhães ◽  
Marina Buldrini Filogonio Seraidarian ◽  
Bernardo Tardin Caetano ◽  
Barbara Oliveira Paixão ◽  
Tassila Oliveira Nery de Freitas ◽  
...  
Keyword(s):  
Case Report ◽  
Cerebral Angiography ◽  
Postpartum Period ◽  
Cerebral Arteries ◽  
Superficial Temporal Artery ◽  
Chronic Administration ◽  
Temporal Artery ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Gnrh Analogue ◽  
Cerebral Vasoconstriction

Context: The Reversible Cerebral Vasoconstriction Syndrome (SVCR) is characterized by rapid and reversible vasoconstriction and segmental dilation of cerebral arteries, usually preceded by thunderclap headache. The involvement of second and third-order branches of the cerebral arteries is the most commom finding in a cerebral angiography. This report is about a SVCR case with atypical involvement, significantly compromising extracranial vessels and raising the hypothesis of association between the use of hormonal blocker gosserelin acetate (ZoladexTM) with SVCR. Case report: Female, 39 years old, with breast cancer and bone metastasis using ZoladexTM that presented with a sudden headache and vomiting, progressing to global afasia and paresis in the right upper limb. Magnetic resonance identified hyperacute intraparenchymal hematoma in left frontoparietal convexity and subarachnoid haemorrhage. Cerebral angiography showed irregularities in the distal branches (M3 and M4) of the middle cerebral arteries, as well as in the superficial temporal artery, characterized by focal strictures. Conclusion: Studies show that hormonal fluctuations in the postpartum period can trigger SVCR due to the drop in estrogen and progesterone (gonadotropins). During postpartum, the stimulus of breastfeeding increases prolactin levels leading to GnRH suppression, which decreases the level of gonadotropins. ZoladexTM is a GnRH analogue and its chronic administration results in suppression of these hormones - similar to the postpartum period. Therefore, there may be an association of hormonal blockers with SVCR.

scholarly journals Reversible cerebral vasoconstriction syndrome in a patient with COVID-19

2021 ◽  
Vol 26 (4) ◽  
pp. 829-834
Author(s):  
Arpan Dutta ◽  
Atanu Chandra ◽  
Subhadeep Gupta ◽  
Biman Kanti Ray ◽  
Deep Das ◽  
...  
Keyword(s):  
Cerebral Angiography ◽  
Rare Complication ◽  
Cerebral Arteries ◽  
Neurological Complications ◽  
Cerebrovascular Diseases ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Angiotensin Converting Enzyme 2 ◽  
Cerebral Vasoconstriction ◽  
Middle Cerebral Arteries ◽  
Novel Coronavirus

COVID-19 infection is well-known to produce different neurological complications, including cerebrovascular diseases. Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by transient segmental vasoconstriction of the cerebral vasculature, has been rarely reported in association with COVID-19 infection. The causative agent, the novel coronavirus (SARS-CoV-2), binds to the angiotensin-converting enzyme 2 (ACE-2) receptors for its entry into the host cell. This leads to downregulation of the ACE-2 and increased activity of the renin-angiotensin-aldosterone (RAAS) axis resulting in sympathetic overactivity and vasoconstriction. This might be the possible mechanism of RCVS in COVID-19. We hereby report a case of RCVS occurring in a SARS-CoV-2 infected patient. This was a 38-year-old male without any comorbidities or risk factors, who presented with headache and confusion. His SARS-CoV-2 RT-PCR was positive. MRI of the brain was normal but cerebral angiography revealed segmental vasoconstriction in bilateral middle cerebral arteries and the terminal part of the internal carotid arteries, which resolved almost completely after 2 weeks. He was treated with oral nimodipine 60 mg every 6 hourly. A database search revealed 2 previous cases of RCVS associated with COVID-19. In conclusion, RCVS is a rare complication of COVID-19. It is possibly under-recognized as only a few COVID-19 patients with headaches undergo cerebral angiography especially when parenchymal brain imaging is normal.

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.

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.

scholarly journals Reversible Cerebral Vasoconstriction Syndrome Induced by Blood Transfusion

2020 ◽  
Vol 38 (4) ◽  
pp. 286-288
Author(s):  
Yoon Kyung Lee ◽  
Byeol-A Yoon ◽  
Dae-Hyun Kim
Keyword(s):  
Blood Transfusion ◽  
Cerebral Arteries ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Red Blood Cell Transfusion ◽  
Clinical Settings ◽  
Blood Transfusions ◽  
Severe Anemia ◽  
Cerebral Vasoconstriction ◽  
Multiple Blood

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headache with reversible vasoconstriction of the cerebral arteries. RCVS has been reported to occur in various clinical settings. However, RCVS triggered by blood transfusion is rare. A 50-year-old woman had severe anemia and received multiple blood transfusions. She developed thunderclap headache after transfusion. Cerebral artery vasoconstrictions were demonstrated by magnetic resonance angiography and transfemoral cerebral angiography. RCVS might be triggered by red blood cell transfusion in patients with severe anemia.

Reversible cerebral vasoconstriction syndrome associated with interferon beta-1a use for multiple sclerosis

2016 ◽  
Vol 22 (12) ◽  
pp. 1626-1628 ◽  
Author(s):  
Tamara Strohm ◽  
Burhan Chaudhry ◽  
Mary A Willis ◽  
Steven Shook
Keyword(s):  
Multiple Sclerosis ◽  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Angiography ◽  
Interferon Beta ◽  
Acute Onset ◽  
Severe Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction ◽  
First Case

Background: Reversible cerebral vasoconstriction syndrome (RCVS) has been associated with multiple medications, cocaine, pregnancy, migraine, and other conditions. Objectives: RCVS associated with interferon beta use has never before been described. Methods: We describe the case of a 20-year-old female who developed acute onset severe headache and was found to have subarachnoid hemorrhage 2 months after initiating Rebif (Interferon beta-1a) for multiple sclerosis (MS). Cerebral angiography showed multiple areas of distal stenosis and dilatation with radiographic resolution 1 month later. Results/conclusions: This is the first case report of RCVS in an MS patient treated with Rebif.

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.

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