ArticlePublisher preview available

Reversible Cerebral Vasoconstriction Syndrome: an Update of Recent Research

March 2020
Current Treatment Options in Rheumatology 6(1)

March 2020
6(1)

Authors:

Cleveland Clinic

Purpose of the review Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches (TCH) and reversible segmental and multifocal vasoconstriction of cerebral arteries. Noninvasive neuroimaging such as computed tomography (CT), and magnetic resonance imaging (MRI) are widely used to assess cerebral vasculature, ischemic or hemorrhagic stroke, and posterior reversible encephalopathy (PRES). The significant differential diagnoses of RCVS center on the clinical presentation of headache and similar radiographic features including aneurysmal subarachnoid hemorrhage (SAH), cervical artery dissection, and central nervous system vasculitis (CNS-V). In this review we present a comprehensive overview of RCVS with the newest findings in the reported literature. Recent findings Pathophysiology: Several surrogate markers including plasma endothelin-1 (E-1) have been investigated to elucidate the pathogenesis of RCVS. Clinical evaluation and diagnosis: The RCVS2 score is a simple scoring system has been proposed to distinguish RCVS from other intracranial vasculopathies. Neuroimaging: High-resolution contract-enhanced MRI (HR-MRI) vessel wall imaging is a feasible tool in differentiating vessel wall patterns of RCVS and CNS-V. Treatment: Early initiation of calcium channel blockers effectively prevents recurrent TCH and shorten the clinical courses. Summary Clinical scoring system and newer imaging tools are helpful for the early distinction of RCVS. These approaches may serve increased sensitivity and specificity for the diagnosis and lead to appropriate management in RCVS patients.

30 years postpartum female with TCH and seizure. A. Initial MRA (day 4) had no significant evidence of arterial narrowing. B. Multiple severe vasoconstrictions were observed in bilateral middle cerebral artery and anterior cerebral artery (arrow-heads) on follow-up MRA (day 11). C. Narrowing arteries dramatically resolved at discharge (day 18).

…

60 year old female with RCVS complicated by lobar hemorrhage and cortical SAH. A. Non- contrast CT images showed left frontal lobal hemorrhage (arrow-head) and right frontal cortical SAH (arrow). B. FLAIR sequence showed left frontal lobar hemorrhage (arrow-head) and cortical SAH on bilateral sulcal space (arrow) as hyper-intense signal. C. Frontal lobal hemorrhage (arrow-head) and (SAH) (arrow) were visualized as hypo-intense signal on T2*-weighted image.

…

DWI and MRA images of 57 year old female with TCH and seizure. A DWI (day 5) showed watershed infarcts (arrow) in the bilateral cerebral hemispheres. B. MRA (day 5) revealed multiple segmental narrowing (arrow-head) in the right anterior cerebral artery and basilar artery. C. Intracranial arterial vasculature was grossly patent with the resolving of vasoconstriction on follow-up MRA (day 11).

…

36 years female represented with PRES and multiple vasoconstrictions after TCH and seizure. A FLAIR sequence demonstrated extensive high-intense signal involving primarily the subcortical white matter of the bilateral frontal parietal and temporal regions (arrows). B. ADC value increased in the subcortical white matter of the bilateral frontal parietal and temporal regions (arrows). C. Multiple segmental narrowing arteries were observed in both anterior and posterior circulations (arrow heads).

…

MRA and HR-MRI post gadolinium contrast in RCVS and CNS-V patients: (A, B) RCVS, (C, D) CNS-V A. MRA showed moderate stenosis in the right MCA (arrow-head). B. HR-MRI revealed no wall enhancement (arrow). C. MRA showed severe narrowing at the junction of the right terminal ICA and right MCA origin (arrow-head). D. HR-MRI revealed marked vessel wall enhancement and thickening (arrow).

…

Figures - available from: Current Treatment Options in Rheumatology

This content is subject to copyright. Terms and conditions apply.

A preview of this full-text is provided by Springer Nature.

Learn more

Content available from Current Treatment Options in Rheumatology

This content is subject to copyright. Terms and conditions apply.

Curr Treat Options in Rheum (2020) 6:55–70

DOI 10.1007/s40674-020-00137-y

’

Reversible Cerebral

Vasoconstriction Syndrome:

an Update of Recent Research

Takashi Shimoyama

Ken Uchino

Rula A. Hajj-Ali

2,*

Address

Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH,

USA

*,2

Department of Rheumatic & Immunologic Disease, Orthopaedic and Rheuma-

tology Institute, Cleveland Clinic, Cleveland, OH, USA

Email: hajjalr@ccf.org

Published online: 24 January 2020

*Springer Nature Switzerland AG 2020

This article is part of the Topical Collection on Vasculitis

KeywordsReversible cerebral vasoconstrictionsyndrome IThunderclap headache IIntracranial vasculopathy IStroke I

Neuroimaging

Abstract

Purpose of the review Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by

recurrent thunderclap headaches (TCH) and reversible segmental and multifocal vasoconstric-

tion of cerebral arteries. Noninvasive neuroimaging such as computed tomography (CT), and

magnetic resonance imaging (MRI) are widely used to assess cerebral vasculature, ischemic or

hemorrhagic stroke, and posterior reversible encephalopathy (PRES). The significant differen-

tial diagnoses of RCVS center on the clinical presentation of headache and similar radiographic

features including aneurysmal subarachnoid hemorrhage (SAH), cervical artery dissection, and

central nervous system vasculitis (CNS-V). In this review we present a comprehensive overview

of RCVS with the newest findings in the reported literature.

Recent findings Pathophysiology: Several surrogate markers including plasma endothelin-1

(E-1) have been investigated to elucidate the pathogenesis of RCVS. Clinical evaluation and

diagnosis: The RCVS

score is a simple scoring system has been proposed to distinguish RCVS

from other intracranial vasculopathies. Neuroimaging: High-resolution contract-enhanced MRI

(HR-MRI) vessel wall imaging is a feasible tool in differentiating vessel wall patterns of RCVS

and CNS-V. Treatment: Early initiation of calcium channel blockers effectively prevents

recurrent TCH and shorten the clinical courses.

Summary Clinical scoring system and newer imaging tools are helpful for the early distinction

of RCVS. These approaches may serve increased sensitivity and specificity for the diagnosis and

lead to appropriate management in RCVS patients.

Vasculitis (L Barra, Section Editor)

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Review of systemic and syndromic complications of cannabis use: A review

Article

Full-text available

Dec 2022
MEDICINE

Purpose of review: Prescribed and non-prescribed cannabis use is common. Providers in specialties treating chronic pain - primary care, pain management, and neurology-will be coming across medical cannabis as a treatment for chronic pain, regardless of whether they are prescribers. It is important to be aware of the systemic and syndromic complications of acute and chronic cannabis use in the differential diagnosis of cardiac, cardiovascular, cerebrovascular, gastrointestinal, and psychiatric disorders. Recent findings: Medical cannabis is legal in 36 states. Studies have shown several potentially serious adverse effects associated with cannabis use. Summary: Cannabis use has the potential to cause several complications that can be easily overlooked without a preexisting high index of suspicion.

Nimodipine-refractory reversible cerebral vasoconstriction syndrome treated effectively with verapamil

Article

Full-text available

Dec 2020

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headache and reversible multifocal vasoconstrictions of the cerebral arteries. There are no treatment guidelines despite its potential for precarious outcomes. A 52-year-old woman with recurrent episodes of severe headache was diagnosed with RCVS and treated with oral nimodipine, which has been widely used for RCVS. However, her vessel status worsened despite treatment for several days and only improved after administration of intra-arterial (IA) and per os (PO) verapamil, which has been used to reverse vasoconstrictions in variant angina. Based on this case and literatures, we propose an alternative strategy using verapamil. The presence of a vascular reaction after an IA verapamil challenge during initial digital subtraction angiography can diagnose RCVS while also serving as an emergent treatment. Based on the response to IA verapamil, PO verapamil can be prescribed if there are no contraindications or side effects.

A case of reversible cerebral vasoconstriction syndrome successfully treated with intravenous fasudilファスジル静脈投与が奏功した可逆性脳血管攣縮症候群の1例

Article

Sep 2022

A 54-year-old woman experienced a thunderclap headache during defecation and bathing. On the eleventh day, she experienced weakness in her right foot. She was admitted to our hospital because of acute cerebral infarction in the left frontal lobe (identified on a magnetic resonance imaging scan of the head) and multiple cerebral vascular stenoses in the bilateral anterior cerebral arteries, bilateral posterior cerebral arteries, and basilar artery (identified on magnetic resonance angiography). She was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) and was started on nicardipine. However, the cerebral infarction spread to both the occipital lobes, and temporal lobes, and she presented with Balint syndrome. She had intracerebral hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage of the right frontal, right temporal, and occipital lobes on the sixteenth day. We started verapamil on the seventeenth day, but vasogenic edema was observed in the corpus callosum on the twenty-first day. Fasudil was started, following which her symptoms and vascular stenosis improved. This is the first report to show that fasudil is effective for RCVS and can be considered clinically important for treatment.

A case of reversible cerebral vasoconstriction syndrome (RCVS) with difficulty in differential diagnosis from bow hunter’s syndromeBow hunter症候群との鑑別を要し，可逆性脳血管攣縮症候群と考えられた1例

Article

Nov 2021

Here, we report the case of a 43-year-old man who presented with transient right visual field loss and numbness and weakness in the right upper and lower limbs in a few days after noticing posterior neck pain while playing golf. Though brain magnetic resonance imaging showed an acute cerebral infarction near the left lateral ventricle, there were no abnormalities identified on brain magnetic resonance angiography. Antithrombotic therapy was initiated; however, 1 week later, the posterior cerebral artery showed segmental stenosis and repeated cerebral infarctions occurred in only the posterior circulation territory over a period of 2 weeks. After lomerizine administration as a treatment for vasoconstriction, the stenosis improved without recurrence. A carotid artery echocardiography revealed markedly decreased blood flow in the right vertebral artery by mechanical stretch, with the probe in a flexed position after leftward rotation, which generally suggested bow hunter’s syndrome. However, the known pathogenetic mechanisms of bow hunter’s syndrome could not explain the present case. Therefore, we presumed that reversible cerebral vasoconstriction syndrome triggered by mechanical stress on the vertebral artery after neck rotation.

Effect of Nimodipine Treatment on the Clinical Course of Reversible Cerebral Vasoconstriction Syndrome

Article

Full-text available

Jun 2019

Background: In reversible cerebral vasoconstriction syndrome (RCVS), nimodipine is currently used for the treatment, although no evidence is available to support its disease-modifying effect. In this prospective observational study, we investigated whether earlier nimodipine treatment can modify the clinical course of reversible cerebral vasoconstriction syndrome. Methods: We prospectively observed patients with angiogram-proven RCVS within 1 month after onset in the Samsung Medical Center between October 2015 and January 2018. Nimodipine was started in all patients immediately after diagnosis. Time from onset to the first nimodipine treatment was categorized as tertiles. We analyzed Kaplan-Meier curve and Cox proportional hazard model to test if the timing of nimodipine treatment can affect the clinical course of thunderclap headaches (TCHs) defined as the duration from onset to remission of thunderclap headaches. Results: In 82 patients included in this study, 71 (86.6%) patients showed remission of TCHs after starting nimodipine treatment. When categorized into earliest (<6 days), early (6–13 days), and late (≥14 days) treatment groups, earlier treatment was significantly associated with shorter clinical courses (median, 2 days [interquartile range 1–3] vs. 7 days [4–10] vs. 10 days [5–15]; log-rank p < 0.001). Univariable and multivariable Cox regression analyses also demonstrated an independent effect of earlier nimodipine treatment on earlier remission of TCHs (adjusted hazard ratio, 0.75 per 1-day delay in treatment; 95% CI, 0.693–0.802, p < 0.001). Conclusions: The clinical course of RCVS differed according to the timing of nimodipine treatment, suggesting the effect of earlier nimodipine treatment. In addition to preventing TCHs, beneficial effects of earlier nimodipine treatment on the progression of vasoconstriction and development of neurological complications should be investigated in future studies.

Reversible Cerebral Vasoconstriction Syndrome: Recognition and Treatment

Article

Full-text available

Apr 2017

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare but increasingly recognized disorder with over 500 cases published in the literature. The condition is characterized by recurrent severe thunderclap headaches with or without other neurological symptoms and diffuse segmental narrowing of the cerebral arteries which is reversible within 3 months. RCVS may occur spontaneously but in over 50% of cases, it is associated with various other conditions, including vasoactive medications or illicit drugs and the post-partum state. One third to a half of cases develop hemorrhagic or ischemic brain lesions or a combination of both. Posterior reversible encephalopathy syndrome (PRES) often occurs in association with RCVS and the conditions are likely to share a common pathophysiology. The pathogenesis of RCVS remains uncertain but autonomic dysregulation, oxidative stress, and genetic predisposition are postulated. Significant differential diagnoses include subarachnoid hemorrhage (SAH) due to aneurysmal rupture, cervical artery dissection, and primary angiitis of the central nervous system (PACNS). Although there is no proven treatment, calcium channel antagonists including nimodipine and verapamil have been administered with reported reduction of headache intensity but without effect on the time course of cerebral vasoconstriction. Glucocorticoids have been reported as an independent predictor of worse outcome and should be avoided. The cornerstone of RCVS management remains largely supportive with bed rest and analgesics and removal of precipitating factors. Invasive neurointerventional techniques should be reserved for severe deteriorating cases. The condition is usually benign and self-limited and the majority of patients have a favorable outcome but around 5–10% are left with permanent neurological deficits and rare cases may die. This review details the importance of the early recognition of this increasingly described condition and current treatment recommendations.

Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome

Article

Full-text available

Dec 2016

Objective: Factors predicting poor outcome in patients with the reversible cerebral vasoconstriction syndrome (RCVS) have not been identified. Methods: In this single-center retrospective study, we analyzed the clinical, brain imaging, and angiography data in 162 patients with RCVS. Univariable and multivariable regression analysis were performed to identify predictors of persistent (nontransient) clinical worsening, radiologic worsening, early angiographic progression, and poor discharge outcome (modified Rankin Scale score 4-6). Results: The mean age was 44 ± 13 years; 78% of patients were women. Persistent clinical worsening occurred in 14% at 6.6 ± 4.1 days after symptom onset, radiologic worsening in 27% (mainly new infarcts), and angiographic progression in 15%. Clinical worsening correlated with angiographic progression and new nonhemorrhagic lesions. Age and sex did not independently predict any type of worsening. Infarction on baseline imaging predicted poor outcome. Prior serotonergic antidepressant use predicted clinical and angiographic worsening but not poor outcome. Intra-arterial vasodilator therapy independently predicted clinical worsening and poor discharge outcome but was offered to more severe cases. Glucocorticoid treatment proved to be an independent predictor of clinical, imaging, and angiographic worsening and poor outcome. Of the 23 patients with clinical worsening, 17 received glucocorticoids (15 within the preceding 2 days). There were no significant differences in baseline brain lesions and angiographic abnormalities between glucocorticoid-treated and untreated patients. Conclusion: Patients with RCVS at risk for worsening can be identified on basis of baseline features. Iatrogenic factors such as glucocorticoid exposure may contribute to worsening.

Triptan-induced Reversible Cerebral Vasoconstriction Syndrome: Two Case Reports with a Literature Review

Article

Full-text available

Dec 2016

We encountered two patients with sumatriptan-induced reversible cerebral vasoconstriction syndrome (RCVS). The present patients were taking sumatriptan for the first time because they had been tentatively diagnosed with a migraine. On reviewing the literature, we found nine other cases of triptan-induced RCVS, predominantly among women aged 30 to 40 years. RCVS has been precipitated by triptan at the first ever use, after daily use, and even with long-term use at a normal dose. Patients with acute onset of severe headache should be thoroughly evaluated, and triptan should be administered appropriately. If triptan-induced RCVS is suspected, vascular imaging should be repeated after several days.

RCVS 2 score and diagnostic approach for reversible cerebral vasoconstriction syndrome

Article

Jan 2019

Objective: To develop a method to distinguish reversible cerebral vasoconstriction syndrome (RCVS) from other large/medium-vessel intracranial arteriopathies. Methods: We identified consecutive patients from our institutional databases admitted in 2013-2017 with newly diagnosed RCVS (n = 30) or non-RCVS arteriopathy (n = 80). Admission clinical and imaging features were compared. Multivariate logistic regression modeling was used to develop a discriminatory score. Score validity was tested in a separate cohort of patients with RCVS and its closest mimic, primary angiitis of the CNS (PACNS). In addition, key variables were used to develop a bedside approach to distinguish RCVS from non-RCVS arteriopathies. Results: The RCVS group had significantly more women, vasoconstrictive triggers, thunderclap headaches, normal brain imaging results, and better outcomes. Beta coefficients from the multivariate regression model yielding the best c-statistic (0.989) were used to develop the RCVS2 score (range -2 to +10; recurrent/single thunderclap headache; carotid artery involvement; vasoconstrictive trigger; sex; subarachnoid hemorrhage). Score ≥5 had 99% specificity and 90% sensitivity for diagnosing RCVS, and score ≤2 had 100% specificity and 85% sensitivity for excluding RCVS. Scores 3-4 had 86% specificity and 10% sensitivity for diagnosing RCVS. The score showed similar performance to distinguish RCVS from PACNS in the validation cohort. A clinical approach based on recurrent thunderclap headaches, trigger and normal brain scans, or convexity subarachnoid hemorrhage correctly diagnosed 25 of 37 patients with RCVS2 scores 3-4 across the derivation and validation cohorts. Conclusion: RCVS can be accurately distinguished from other intracranial arteriopathies upon admission, using widely available clinical and imaging features. Classification of evidence: This study provides Class II evidence that the RCVS2 score accurately distinguishes patients with RCVS from those with other intracranial arteriopathies.

Primary angiitis of the CNS and reversible cerebral vasoconstriction syndrome: A comparative study

Article

Sep 2018

Objectives: To further improve the distinction between primary angiitis of the CNS (PACNS) and reversible cerebral vasoconstriction syndrome (RCVS). Methods: We compared 2 large French cohorts of patients with PACNS (n = 110, retrospectively and prospectively enrolled) and RCVS (n = 173, prospectively enrolled). Results: Patients with RCVS were predominantly female (p < 0.0001), with migraines (p < 0.0001), and were more often exposed to vasoactive substances (p < 0.0001) or postpartum (p = 0.002) than patients with PACNS. Headache, especially thunderclap headache, was more frequent in RCVS (both p < 0.0001). Thunderclap headache was absent in only 6% of patients with RCVS and was mainly recurrent (87%) and provoked (77%) mostly by sexual intercourse, exertion, or emotion. All other neurologic symptoms (motor deficit, seizure, cognitive disorder, or vigilance impairment, all p < 0.0001) were more frequent in PACNS. At admission, brain CT or MRI was abnormal in all patients with PACNS and in 31% of patients with RCVS (p < 0.0001). Acute ischemic stroke was more frequent in PACNS than in RCVS (p < 0.0001). Although intracerebral hemorrhage was more frequent in PACNS (p = 0.006), subarachnoid hemorrhage and vasogenic edema predominated in RCVS (p = 0.04 and p = 0.01, respectively). Multiple small deep infarcts, extensive deep white matter lesions, tumor-like lesions, or multiple gadolinium-enhanced lesions were observed only in PACNS, whereas cervical artery dissection was found only in RCVS. Conclusions: Our study confirms that careful analysis of clinical context, headache features, and patterns of brain lesions can distinguish PACNS and RCVS within the first few days of admission in most cases. However, diagnosis remains challenging in a few cases.

Reversible cerebral vasoconstriction syndrome in 2017

Article

Mar 2017

Anne Ducros

Résumé Le syndrome de vasoconstriction cérébrale réversible associe des céphalées sévères, typiquement en coup de tonnerre et multiples, et une vasoconstriction segmentaire diffuse des artères cérébrales, régressive en 3 mois. Il est attribué à un dysfonctionnement transitoire de la régulation du tonus vasculaire cérébral, d’évolution le plus souvent favorable. Cependant, un œdème cérébral, des hémorragies intracrâniennes ou des infarctus cérébraux peuvent survenir d’emblée ou après une phase de céphalées isolées. Ces complications peuvent probablement être évitées par une prise en charge précoce dès les premières céphalées. Le diagnostic est difficile lorsque l’angiographie initiale est normale, comme dans 20 % des cas, car la vasoconstriction culmine 2 à 3 semaines après le début. Plus de la moitié des cas surviennent après consommation de substances vasoactives ou lors du post-partum. Le traitement consiste en l’éviction des substances vasoactives, le repos et le contrôle de la pression artérielle. La nimodipine semble réduire les céphalées, mais ne prévient pas complètement les AVC.

Reversible Cerebral Vasoconstriction Syndrome in Pediatrics: A Case Series and Review

Article

Mar 2017

Reversible cerebral vasoconstriction syndrome is a transient vasculopathy associated with severe headaches and stroke. In most cases of reversible cerebral vasoconstriction syndrome, there is a precipitating event or trigger, such as pregnancy, serotonin agonist treatment or illicit drug use. The authors present 2 pediatric cases of reversible cerebral vasoconstriction syndrome and review the previous 11 pediatric cases in the literature. In many instances, the clinical and radiographic features are similar in both pediatric and adult cases. In the pediatric group, reported potential triggers include trauma (1/13), exercise (2/13), water to the face (3/13), hypertension (3/13), and medication or substance use (4/13). One surprising difference is that 11 out of 13 pediatric patients with reversible cerebral vasoconstriction syndrome are male while most cases in adults are female. Many of the pediatric patients with reversible cerebral vasoconstriction syndrome were treated with a calcium channel blocker and the overall outcome of pediatric reversible cerebral vasoconstriction syndrome was good, with most patients experiencing a full recovery.

Reversible Cerebral Vasoconstriction Syndromes

Chapter

Dec 2017

The reversible cerebral vasoconstriction syndrome includes a group of conditions unified by dynamic and reversible changes in the caliber of intracranial arteries, usually accompanied by recurrent thunderclap headaches. Women are predominantly affected. The etiology is unknown; however, several triggers are recognized including vasoconstrictive drug use and childbirth. Brain imaging can remain normal, but about half develop infarcts, convexal (non-aneurysmal) subarachnoid hemorrhages, lobar hemorrhages, or reversible brain edema. The condition is invariably self-limited with resolution of clinical and angiographic abnormalities within 3 months. Glucocorticoid therapy has been associated with worse outcome. Progressive vasoconstriction can occur resulting in significant disability or death in rare cases. The vast majority have excellent long-term outcome without recurrences.

Hemorrhagic Reversible Cerebral Vasoconstriction Syndrome: Features and Mechanisms

Article

Jun 2016

Background and purpose: To compare hemorrhagic and nonhemorrhagic reversible cerebral vasoconstriction syndromes (RCVS) with a view to understand mechanisms. Methods: This single-center retrospective study included 162 patients with RCVS. Clinical, brain imaging, and angiography data were analyzed. Results: The mean age was 44±13 years, 78% women. Hemorrhages occurred in 43% including 21 patients with intracerebral hemorrhage (ICH) and 62 with convexal subarachnoid hemorrhage (cSAH). The frequency of triggers (eg, vasoconstrictive drugs) and risk factors (eg, migraine) were not significantly different between hemorrhagic and nonhemorrhagic RCVS or between subgroups (ICH versus non-ICH, isolated cSAH versus normal scan). Hemorrhagic lesions occurred within the first week, whereas infarcts and vasogenic edema accumulated during 2 to 3 weeks (P<0.001). Although all ICHs occurred before cSAH, their time course was not significantly different (P=0.11). ICH and cSAH occurred earlier than infarcts (P≤0.001), and ICH earlier than vasogenic edema (P=0.009). Angiogram analysis showed more severe vasoconstriction in distal versus proximal segments in all lesion types (ICH, cSAH, infarction, vasogenic edema, and normal scan). The isolated infarction group had more severe proximal vasoconstriction, and those with normal imaging had significantly less vasoconstriction. Multivariable analysis failed to uncover independent predictors of hemorrhagic RCVS; however, female sex predicted ICH (P=0.048), and angiographic severity predicted infarction (P=0.043). Conclusions: ICH and cSAH are common complications of RCVS. Triggers and risk factors do not predict lesion subtype but may alter central vasomotor control mechanisms resulting in centripetal angiographic evolution. Early distal vasoconstriction is associated with lobar ICH and cSAH, and delayed proximal vasoconstriction with infarction.

Reversible Cerebral Vasoconstriction Syndrome: an Update of Recent Research

Abstract and Figures

Recommended publications

Reversible cerebral vasoconstriction syndrome in children: an update

DIAGNOSTICS OF REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME: CLINICAL MANIFESTATION AND IMAGING PAT...

Thunderclap headache and reversible cerebral vasoconstriction syndrome: Current theory and accumulat...

Reversible Cerebral Vasoconstriction Syndrome: Recognition and Treatment

Type of headache at onset and risk for complications in reversible cerebral vasoconstriction syndrom...