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Reversible cerebral vasoconstriction syndrome: Is it more than just cerebral vasoconstriction?

Seby John1, Rula A Hajj-Ali2, David Min3

  • 1Cerebrovascular Center, Cleveland Clinic, OH, USA.

Cephalalgia : an International Journal of Headache
|August 29, 2014
PubMed

Insights

Systemic vascular alterations are newly observed in reversible cerebral vasoconstriction syndrome (RCVS). Some RCVS patients experience cardiac dysfunction, with a few showing complete recovery from cardiomyopathy.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Reversible cerebral vasoconstriction syndrome (RCVS) is typically characterized by cerebral artery spasms.
  • Systemic vascular involvement beyond the brain has not been previously described in RCVS.
  • Cardiac dysfunction has not been a recognized feature of RCVS.

Observation:

  • This case series investigated cardiac function in RCVS patients during acute ictus.
  • Transthoracic echocardiography (TTE) was used to assess left ventricular ejection fraction (LVEF) and wall motion abnormalities (WMA).
  • 18 of 68 RCVS patients (26%) underwent TTE during ictus.

Findings:

  • Three patients (17%) exhibited WMA on initial TTE.
  • These patients were female, with no prior history of coronary artery disease or heart failure.
  • WMA resolved in two patients; persistent global left ventricular dysfunction was noted in one patient at 90 days.

Implications:

  • Cardiac ventricular abnormalities may represent a broader spectrum of RCVS manifestations.
  • The observed cardiomyopathy might stem from localized coronary vasoconstriction leading to myocardial ischemia.
  • RCVS-associated vasoconstriction may extend beyond cerebral vasculature to affect extracerebral organs.
Abstract

Keywords:
Reversible cerebral vasoconstriction syndrome (RCVS)cardiomyopathyheart-brain connectionstress-induced cardiomyopathytransient

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