Cerebral endothelial dysfunction in reversible cerebral vasoconstriction syndrome: a case-control study.

Area of Science:

• Neurology
• Vascular Biology
• Neuroimaging

Background:

• Reversible cerebral vasoconstriction syndrome (RCVS) is a condition characterized by temporary narrowing of brain arteries.
• Cerebral endothelial dysfunction may play a role in the pathophysiology of RCVS.

Purpose of the Study:

• To investigate cerebral endothelial dysfunction in patients diagnosed with RCVS.
• To compare endothelial function between RCVS patients, individuals with episodic migraine, and healthy controls.

Main Methods:

• Prospective recruitment of 84 participants (28 per group: RCVS, migraine, healthy controls).
• Transcranial Doppler (TCD) ultrasound with a breath-holding maneuver to assess the breath-holding index (BHI), a measure of cerebral endothelial-dependent vasodilation.
• Evaluation of bilateral middle cerebral arteries (MCAs), posterior cerebral arteries (PCAs), and basilar artery (BA).
• Follow-up BHI measurements at 3 months for a subset of RCVS patients.

Main Results:

• RCVS patients exhibited significantly lower BHIs across all assessed basal arteries compared to healthy controls.
• Compared to migraineurs, RCVS patients showed reduced BHIs specifically in the anterior circulation (MCAs).
• Of 10 RCVS patients with follow-up, 7 demonstrated normalization of BHI after 3 months, while 3 did not.

Conclusions:

• Cerebral endothelial function is impaired in a widespread manner in patients with RCVS.
• The findings suggest that endothelial dysfunction is a significant feature of RCVS.
• Further research is warranted to elucidate the precise role of endothelial dysfunction in RCVS pathogenesis and clinical outcomes.