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Reversible Cerebral Vasoconstriction Syndrome in Pediatrics: A Case Series and Review
Samantha W Coffino1, Robert H Fryer1
11 Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Insights
Reversible cerebral vasoconstriction syndrome (RCVS) in children often presents similarly to adults but predominantly affects males. Treatment with calcium channel blockers typically leads to a good recovery.
Area of Science:
- Neurology
- Vascular Neurology
Background:
- Reversible cerebral vasoconstriction syndrome (RCVS) is a condition characterized by temporary narrowing of brain arteries, often leading to severe headaches and stroke.
- RCVS is frequently associated with specific triggers like pregnancy, certain medications, or drug use.
Observation:
- This study reviews 13 pediatric cases of RCVS, including 2 new cases and 11 from existing literature.
- Pediatric RCVS shares many clinical and radiographic features with adult cases.
- Identified triggers in pediatric RCVS include trauma, exercise, water exposure, hypertension, and substance use.
Findings:
- A notable difference in pediatric RCVS is the male predominance (11 out of 13 patients), contrasting with the female predominance in adult cases.
- Calcium channel blockers were a common treatment modality for pediatric patients.
- The overall prognosis for pediatric RCVS is favorable, with most patients achieving full recovery.
Implications:
- Understanding pediatric RCVS triggers and demographics aids in early diagnosis and management.
- The findings highlight the importance of considering RCVS in pediatric patients presenting with severe headaches and neurological deficits.
- Further research into the sex-based differences in RCVS could elucidate underlying pathophysiological mechanisms.
Abstract:
Reversible cerebral vasoconstriction syndrome is a transient vasculopathy associated with severe headaches and stroke. In most cases of reversible cerebral vasoconstriction syndrome, there is a precipitating event or trigger, such as pregnancy, serotonin agonist treatment or illicit drug use. The authors present 2 pediatric cases of reversible cerebral vasoconstriction syndrome and review the previous 11 pediatric cases in the literature. In many instances, the clinical and radiographic features are similar in both pediatric and adult cases. In the pediatric group, reported potential triggers include trauma (1/13), exercise (2/13), water to the face (3/13), hypertension (3/13), and medication or substance use (4/13). One surprising difference is that 11 out of 13 pediatric patients with reversible cerebral vasoconstriction syndrome are male while most cases in adults are female. Many of the pediatric patients with reversible cerebral vasoconstriction syndrome were treated with a calcium channel blocker and the overall outcome of pediatric reversible cerebral vasoconstriction syndrome was good, with most patients experiencing a full recovery.
