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Reversible Cerebral Vasoconstriction Syndrome

RCVS


Presentation

  • We report the case of a 55-year-old woman who presented with headache and multifocal intracerebral haemorrhage.[ncbi.nlm.nih.gov]
Weakness
  • He had transient and crescendo neurologic events in the first 3 postoperative weeks that culminated in right hand weakness and paresthesia, despite dual antiplatelet therapy, maximal anticoagulation, and undergoing stenting of the endarterectomy site.[ncbi.nlm.nih.gov]
  • This is especially true if any weakness, loss of sensation or balance, change in vision, or change in level of consciousness occurs.[azmedmj.org]
  • Other symptoms may include: Seizures Changes in vision Difficulty understanding others when they are speaking Difficulty speaking Weakness on one side of the body RCVS patients are at risk of experiencing a stroke or transient ischemic attack (TIA).[cedars-sinai.edu]
High Fever
  • She initially presented with high fever and pancytopenia, leading to a diagnosis of most severe type aplastic anemia. We treated her with cyclosporine, methylprednisolone and anti-thymocyte globulin.[ncbi.nlm.nih.gov]
Nausea
  • A 7-year-old girl had a mild acute headache with nausea after swimming. She subsequently developed hemi-convulsions followed by right hemiplegia.[ncbi.nlm.nih.gov]
  • Nausea and vomiting were reported at the onset of headache in seven patients.[ceemjournal.org]
  • Waxing‐waning headaches persisted, accompanied by nausea, vomiting, dizziness, photophobia, and visual scotomas. Her admission neurological examination and head CT were normal.[shmabstracts.com]
  • […] both eyes Sudden trouble walking Sudden dizziness, loss of balance or coordination Sudden, severe headache with no known cause The effects of an acute ischemic stroke may cause additional symptoms in women including: Face, arm or leg pain Hiccups or nausea[cedars-sinai.edu]
Colic
  • We report a case of a 51-year-old female with RCVS after administration of indomethacin given to relieve pain caused by renal colic.[ncbi.nlm.nih.gov]
Hypertension
  • The variable nature of the headache and the degree of associated hypertension raised the clinical suspicion of reversible cerebral vasoconstriction syndrome, confirmed on MR angiography.[ncbi.nlm.nih.gov]
  • Results: We report a case of RCVS-related ICH leading to refractory intracranial hypertension. A decompressive craniectomy was performed to control intracranial pressure. We discuss here the management of RCVS with intracranial hypertension.[karger.com]
Photophobia
  • Waxing‐waning headaches persisted, accompanied by nausea, vomiting, dizziness, photophobia, and visual scotomas. Her admission neurological examination and head CT were normal.[shmabstracts.com]
  • The onset is usually recurrent sudden-onset and severe headaches that are often accompanied by nausea, vomiting, photophobia, confusion and blurred vision [ 7, 28 ].[ncbi.nlm.nih.gov]
  • The headaches may be accompanied by nausea, vomiting and photophobia. Most headaches are bilateral and involve the occipital region.[medsafe.govt.nz]
  • 95% of patients experience. [1] In two-thirds of cases, it is the only symptom. [1] These headaches are typically bilateral, very severe and peak in intensity within a minute. [1] They may last from minutes to days, and may be accompanied by nausea, photophobia[en.wikipedia.org]
  • […] are “secondary” 6 Clinical Presentation Headache (secondary) - “thunderclap variety”, peaks within one minute and very intense Only symptom in 75% Multiple over 1-4 week period is almost pathognomonic Usually posterior and bilateral Nausea/vomiting, photophobia[slideplayer.com]
Suggestibility
  • However, our case suggests that diffuse cerebral vasodilatation may in fact be evident during the early stage of disease.[ncbi.nlm.nih.gov]
Seizure
  • Thunderclap headache is the usual primary symptom; seizure is uncommon. During the postpartum period, seizure is a significant concern.[ncbi.nlm.nih.gov]
  • Case Report: We present 49-year-old and 46-year-old females with thunderclap headache and seizure. MRI shows reversible cortical and subcortical lesions in both fronto-parieto-occipital lobes.[e-jnc.org]
Confusion
  • Moreover, a subset of patients with severe RCVS presents without any headache, but frequently with seizures, focal neurological deficits, confusion or coma, in the setting of stroke or posterior reversible encephalopathy syndrome.[ncbi.nlm.nih.gov]
  • Headache may be associated with agitation, confusion, nausea, vomiting, phonophobia, photophobia and sometimes collapse.[em-consulte.com]
  • […] vasoconstriction syndromes (RCVS), a diverse group of conditions characterized by reversible vasoconstriction and sudden thunderclap headache with or without associated neurologic deficits, have been poorly differentiated in the literature and are frequently confused[mdedge.com]
Tonic-Clonic Seizure
  • However, he then presented with a sudden severe headache, vomiting, and generalized tonic-clonic seizure.[ncbi.nlm.nih.gov]
  • Her blood pressure on tonic-clonic seizure was 192/108 mmHg. On admission to our hospital, the patient was alert and conscious, but had severe headache over the temples with a positive Kernig's sign.[ijcasereportsandimages.com]
  • Among 3 patients displaying seizures, 2 had generalized tonicclonic seizures (GTCS) and the rest had focal motor seizure turning into GTCS.[ojrd.biomedcentral.com]
Ataxia
  • […] period of one to four weeks. [1] A milder, residual headache persists between severe attacks for half of patients. [1] 1–17% of patients experience seizures. 8–43% of patients show neurologic problems, especially visual disturbances, but also hemiplegia, ataxia[en.wikipedia.org]
Clonus
  • Through the course of hospitalization, both patients developed rigidity, diaphoresis, fever, tachycardia with labile blood pressures and clonus on examination.[ncbi.nlm.nih.gov]

Workup

  • Thunderclap headache requires urgent workup to identify the underlying cause. Although SAH is the most important diagnosis to exclude in the first instance, emergency physicians should be aware of other causes and how they present, such as RCVS.[ncbi.nlm.nih.gov]

Treatment

  • Current treatments, guided only by expert consensus, have no proven effect on these complications, which argues the need for accurate identification of patients with RCVS and prospective studies to validate treatment and inform prognoses.[ncbi.nlm.nih.gov]

Prognosis

  • Cerebral vasoconstriction is reversible, and most cases have good prognosis. However, clinical outcome is possibly severe when it is complicated by stroke, yet detailed reports on such a case are few.[ncbi.nlm.nih.gov]

Etiology

  • Cough headache can be a primary benign condition or secondary to underlying etiologies. We herein describe a case of a 52-year-old woman with cough headache that presented as reversible cerebral vasoconstriction syndrome (RCVS).[ncbi.nlm.nih.gov]
  • Patients with cSAH due to other etiologies (amyloid angiopathy, posterior reversible leukoencephalopathy syndrome [PRES], cerebral venous thrombosis, or other) were excluded.[neurology.org]
  • Like postpartum takotsubo cardiomyopathy, the etiology of postpartum cerebral vasoconstriction syndrome is thought to involve stress-induced, elevated levels of catecholamines and vasoconstrictive agents.[degruyter.com]
  • Applicable To Call-Fleming syndrome Code First Code First Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]

Epidemiology

  • However, epidemiological, clinical and genetic data suggest that these conditions share common and complex features and are, at least partly, linked.[ncbi.nlm.nih.gov]
  • "Reversible Cerebral Vasoconstriction Syndrome, Part 1 Epidemiology, Pathogenesis, and Clinical Course" (PDF). Ducros A (2012). "Reversible cerebral vasoconstriction syndrome" (PDF).[en.wikipedia.org]
  • Presentation on theme: "Reversible Cerebral Vasoconstriction Syndrome"— Presentation transcript: 1 Reversible Cerebral Vasoconstriction Syndrome Pat McCormick, MS4 Chicago Medical School & University of North Carolina 2 Outline Definition Epidemiology[slideplayer.com]
  • Well-designed epidemiologic studies have not allowed for a definite conclusion that marijuana causes RCVS, but marijuana appears frequently as a proposed precipitating event or cause in cases that are described in the medical literature.[azmedmj.org]
Sex distribution
Age distribution

Pathophysiology

  • The current underlying pathophysiology is thought to be a disturbance in cerebrovascular tone leading to vasoconstriction.[ncbi.nlm.nih.gov]

Prevention

  • Immediate magnetic resonance angiography is essential to diagnose this syndrome, and a prompt application of calcium channel inhibitors should be considered to resolve constriction of the vessels and to prevent subsequent brain damage.[ncbi.nlm.nih.gov]
  • Highlights new information on genetic risk factors; primary prevention of stroke; infectious diseases and stroke; recovery interventions such as robotics, brain stimulation, and telerehabilitation; and trial design.[books.google.com]

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