Introduction:
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is described as reversible constriction of cerebral arteries, presenting with severe headaches and associated with hemorrhagic or ischemic strokes. There is a dearth of the literature on demographics and risk factors associated with intracranial hemorrhage (ICH) in patients with RCVS in the US.
Methods:
All patients with a primary or secondary diagnosis of RCVS in 2016 Nationwide Readmission Database (NRD) using ICD-10 code I67.841 after excluding cerebral angiitis (N=57). Unique patients were included using a unique patient identifier. Weighted discharges were used to generate national estimates. ICH was defined as both intraparenchymal and subarachnoid hemorrhage. A multivariable logistic model was used to identify ICH predictors.
Results:
Among total 1,152 RCVS patients, 25.7% (296) patients developed ICH. Patients with ICH mean age was (years) (Mean±SE) 47.8 ±1.2 vs. 47.0±1.1 (P=0.62), female 85.4% vs. 78.0% (P=0.06), longer inpatient LOS 12.1±0.9 vs. 6.4±0.5 days (P<0.0001) and higher inpatient cost 42,638±4,451 vs. 18,199±1,117 (P=0.018). After multivariable analysis, two independent predictors of ICH were identified: increasing age (OR 1.02, 95% CI: 1.01-1.04, P=0.042) and female gender (OR 2.37, 95%CI: 1.25-4.50, P=0.009). Patients with ICH were at a greater risk of cerebral edema (OR 13.25, 95% CI: 5.10-34.43, P<0.0001) (Figure). Among disposition, 63.2% of patients with ICH were discharged home requiring no assistance and no mortality was observed.
Conclusion:
This nationally representative sample suggests that increasing age and female gender were independent predictors of ICH. There is no difference in comorbidities including migraine contrary to prior literature, modifiable lifestyle risk factors and pregnancy in this cohort. Excellent outcome was observed as the majority of patients were discharged home. Higher LOS and cost were reported in ICH cohort.
Vessel Wall MRI in HIV-Associated Cerebral Angiitis
