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Reversible cerebral vasoconstriction syndrome: a comprehensive systematic review.

T-J Song1, K H Lee, H Li

  • 1Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, South Korea. shinji@yuhs.ac.

European Review for Medical and Pharmacological Sciences
|May 18, 2021
PubMed
Summary

Vasoactive substances frequently trigger reversible cerebral vasoconstriction syndrome (RCVS), often presenting with multifocal stenosis. Trauma or surgery increases the risk of neurological deficits in RCVS patients.

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Area of Science:

  • Neurology
  • Neuroscience
  • Vascular Neurology

Background:

  • Reversible cerebral vasoconstriction syndrome (RCVS) is a condition characterized by temporary narrowing of brain arteries.
  • Understanding its triggers, clinical course, and outcomes is crucial for patient management.

Purpose of the Study:

  • To analyze the clinical characteristics, treatment patterns, and prognosis of patients diagnosed with RCVS.
  • To identify risk factors associated with residual neurological deficits after RCVS.

Main Methods:

  • A systematic review of PubMed and EMBASE databases was conducted.
  • 191 cases of RCVS were included, with data collected on demographics, triggers, imaging, treatments, recurrence, and outcomes.
  • Multivariate analysis was used to identify independent risk factors for neurological deficits.

Main Results:

  • The study included 191 patients, predominantly female (81.2%), with a mean age of 39.9 years.
  • Vasoactive substances (41.4%) were the most common trigger, followed by pregnancy/postpartum (20.9%).
  • Multifocal stenosis (84.0%) and beading (82.4%) were common angiographic findings. Trauma/surgery (HR: 3.29) and focal neurological deficits (HR: 3.83) independently predicted worse outcomes.

Conclusions:

  • Vasoactive substances are frequent triggers for RCVS, often associated with multifocal stenotic lesions on angiography.
  • Patients experiencing RCVS due to trauma/surgery or presenting with focal cortical deficits face a higher risk of long-term neurological deficits.
  • Close monitoring is recommended for high-risk RCVS patients to mitigate potential residual neurological deficits.