The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients

We present the first large prospective study of RCVS, based on the 67 consecutive patients with angiographically proven reversible vasoconstriction who were prospectively diagnosed in our institution in the last 3 years

A. Ducros

2007

Scholarcy highlights

  • We present the first large prospective study of RCVS, based on the 67 consecutive patients with angiographically proven reversible vasoconstriction who were prospectively diagnosed in our institution in the last 3 years
  • Patients who satisfied the three following diagnostic criteria for RCVS were included: unusual, recent, severe headaches of progressive or sudden onset, with or without focal neurological deficit and/or seizures; cerebral vasoconstriction assessed by Magnetic resonance angiography or conventional angiography, with at least two narrowings per artery on two different cerebral arteries; disappearance of arterial abnormalities in less than 3 months
  • Half the patients reported a history of primary headache disorder, episodic tension-type headache being the most common, followed by migraine without aura, migraine with aura, episodic cluster headache and chronic tension type headache
  • This important recruitment is explained by the presence in Lariboisiere hospital of both an emergency headache centre in which about 8000 patients are seen every year and a neurology department with both a longstanding interest in headache and a stroke unit
  • In the absence of large prospective series, the exact incidence of stroke is unknown, but has been estimated to range from 7% up to 54%
  • All patients presenting to our institution with a chief complaint of thunderclap or acute severe headaches undergo a standardized diagnosis procedure including CT scan, LP, MRI with MRA, cervical and transcranial ultrasound investigations and eventually conventional angiography
  • The different time courses of thunderclap headaches, vasoconstriction, cortical subarachnoid haemorrhage and strokes suggest that the responsible vasospastic disorder starts in small distal arteries and progresses towards medium sized and large arteries

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