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Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
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Reversible cerebral vasoconstriction syndrome.

Anne Ducros1, Marie-Germaine Bousser

  • 1Emergency Headache Centre, Assistance Publique des Hôpitaux de Paris, Head and Neck Centre, Lariboisière Hospital, 2 rue Ambroise Paré, Paris Cedex 10, France. anne.ducros@lrb.aphp.fr

Practical Neurology
|September 19, 2009
PubMed
Summary

Reversible cerebral vasoconstriction syndrome (RCVS) causes severe headaches and neurological issues due to temporary brain artery narrowing. Diagnosis involves angiography showing a "string of beads" pattern that resolves over time.

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Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Reversible cerebral vasoconstriction syndrome (RCVS) presents with severe headaches, seizures, and focal neurological deficits.
  • Characterized by temporary constriction of cerebral arteries, RCVS typically resolves within 1-3 months.
  • It predominantly affects females around age 45, with 60% of cases being secondary to postpartum or vasoactive substance exposure.

Purpose of the Study:

  • To summarize the key features, complications, diagnostic criteria, and treatment outcomes of Reversible Cerebral Vasoconstriction Syndrome.
  • To highlight the diagnostic challenges and the natural course of RCVS.

Main Methods:

  • Review of clinical presentation, demographic data, and triggers for RCVS.
  • Analysis of diagnostic findings, particularly angiographic characteristics.
  • Evaluation of complications such as subarachnoid hemorrhage and ischemic/hemorrhagic strokes.
  • Assessment of treatment efficacy, specifically Nimodipine's effect on symptoms and complications.

Main Results:

  • RCVS is associated with severe headaches, neurological deficits, and characteristic "string of beads" appearance on angiography.
  • Major complications include subarachnoid hemorrhage (22%) and ischemic or hemorrhagic strokes (7%), potentially leading to permanent sequelae.
  • Nimodipine may alleviate thunderclap headaches within 48 hours but does not definitively impact hemorrhagic or ischemic complications.

Conclusions:

  • RCVS is a distinct neurological condition requiring specific diagnostic criteria, including resolution of vasoconstriction on repeat angiography.
  • While Nimodipine offers symptomatic relief for headaches, its role in preventing major complications remains uncertain.
  • Understanding RCVS pathophysiology and natural history is crucial for appropriate patient management and prognosis.