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.

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.

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.

scholarly journals OnabotulinumtoxinA injections: treatment of reversible cerebral vasoconstriction syndrome chronic daily headaches

2019 ◽  
Vol 12 (5) ◽  
pp. e228562
Author(s):  
Ricardo Senno ◽  
Ethan Schonfeld ◽  
Charulatha Nagar
Keyword(s):  
Case Report ◽  
Pain Relief ◽  
Mechanism Of Action ◽  
Cerebral Arteries ◽  
Rare Condition ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction ◽  
Novel Treatment ◽  
Patient Reported ◽  
Chronic Daily Headaches

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare condition characterised by repetitive, multifocal, vasofluctuations of cerebral arteries. A key symptom is chronic, disabling ‘thunderclap’ headaches, which are extremely difficult to treat as established medications may exacerbate the pathophysiology of RCVS. OnabotulinumtoxinA (OBT-A) injections are used for the prophylaxis of chronic daily headaches (CDH). The mechanism of action of OBT-A significantly differs from oral headache treatments. Thus, OBT-A may be an effective, safe treatment of RCVS-CDH. A 51-year-old woman with RCVS-CDH presented to outpatient clinic. This case report describes the first, believed, documented treatment of RCVS-CDH by OBT-A injections. In 2018, the consented patient received a total of 200 units of OBT-A, 155 units to the 31 approved U.S. Food and Drug Administration (FDA) sites and 45 units injected into the bilateral occipital belly of occipitofrontalis muscles. The patient reported 3 months of excellent pain relief (60% reduction). Three rounds of OBT-A injection, each 3 months apart, resulted in 80% reduction. OBT-A injections may prove a successful, novel treatment for RCVS-CDH.

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.

scholarly journals Síndrome de Vasoconstrição Cerebral Reversível: uma Causa Importante de Acidentes Vasculares Cerebrais no Puerpério

2014 ◽  
Vol 27 (4) ◽  
pp. 515 ◽  
Author(s):  
Tiago Rodrigues ◽  
Rui Loureiro ◽  
Raquel Samões ◽  
Viriato Alves ◽  
Cristina Ramos ◽  
...  
Keyword(s):  
Cerebral Vasospasm ◽  
Postpartum Period ◽  
Cerebral Arteries ◽  
Morbidity And Mortality ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebrovascular Disorder ◽  
Imaging Studies ◽  
Neurologic Symptoms ◽  
Cerebral Vasoconstriction

Reversible cerebral vasoconstriction syndrome is a rare cerebrovascular disorder characterized by cerebral arterial segmental vasoconstriction, usually spontaneously reversible. This disease can occur in the postpartum period, manifesting itself through acute neurologic symptoms, and the imaging studies play a fundamental role in its diagnosis. Although classically considered a benign and self-limiting disease, it may present less favorable courses with significant associated morbidity and mortality. We describe a case of reversible cerebral vasoconstriction syndrome in the puerperium, with progressive cerebral vasospasm causing ischemic and hemorrhagic strokes. We intend to make an alert to the potential complications of this entity that demand a close clinical and imagiological monitoring.<br /><strong>Keywords:</strong> Stroke; Cerebral Arteries; Puerperal Disorders; Vasoconstriction; Vasospasm, Intracranial.

Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations

1971 ◽  
Vol 34 (5) ◽  
pp. 706-708 ◽  
Author(s):  
Martin L. Lazar ◽  
Clark C. Watts ◽  
Bassett Kilgore ◽  
Kemp Clark
Keyword(s):  
Cerebral Angiography ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Operative Procedure ◽  
Superficial Temporal Artery ◽  
Technical Problem ◽  
Temporal Artery ◽  
Content Type ◽  
Actual Operation ◽  
Fine Print

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.

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