Reversible Cerebral Vasoconstriction Syndromes (RCVS)

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<strong>RCVS</strong> • Group of conditions characterized by reversible segmental constriction-dilatation of cerebral arteries • ~90% have recurrent ‘thunderclap’ headaches • Brain MRI can be normal or show ischemic stroke, ICH, cSAH, or reversible brain edema (PRES) • Usually a self-limited condition with benign outcome • Angiographic reversal occurs within days to weeks • Pathophysiology: ?abnormal cerebral vascular tone Singhal et al., Arch Neurol 2011; Calabrese et al., Ann Int Med 2007; Ducros et al., Brain 2007; Chen et al., Ann Neurol 2008, 2010
Next Steps International Collaboration Validate provisional diagnostic criteria Define relationships with PRES and TCH Clarify whether drugs can precipitate <strong>RCVS</strong> Pathophysiology – biomarkers, autoregulation Investigate treatments e.g. nimodipine What’s first, headache or vasoconstriction? Why ‘segmental’? Why prolonged?
Page 1 and 2: Reversible Cerebral Vasoconstrictio
Page 3 and 4: Patients (mostly women): rTCH ± st
Page 5 and 6: Key Elements for Diagnosis 1. Sever
Page 7 and 8: Characteristic Clinical Features CC
Page 9: Laboratory and Imaging Features Cha
Page 12 and 13: Characteristic Follow-up Imaging CC
Page 14 and 15: RCVS: Brain Imaging
Page 16 and 17: Brain Hemorrhage in RCVS Hemorrhage
Page 18 and 19: • Migraine Differential Diagnosis
Page 20 and 21: Diagnostic Approach 1. Clinical Rec
Page 22 and 23: Characteristic Treatment and Outcom
Page 24 and 25: CTA before IA treatment (PPD 20) Si
Page 26 and 27: Final MRI 6 Days After Admission Si
Page 31 and 32: Stroke attributed to ‘vasospasm
Page 36 and 37: Hemorrhages in 1 st week, Infarcts
Page 38 and 39: Pathophysiology
Page 40 and 41: A B C (A) Headframe used for bedsid
Page 42 and 43: Perivascular nerves smooth muscle c
Page 44 and 45: Endothelium • Modulates vascular
Page 46 and 47: Spectrum - disorders of cerebrovasc
Page 48 and 49: RCVS and Drugs/Meds Ergot derivativ
Page 50 and 51: Serotonin - central role in RCVS? S
Page 52 and 53: Serotonergic meds common…but RCVS
Page 54 and 55: RCVS and Migraine Is RCVS simply a
Page 56 and 57: Neurology 2006: 67:2164 • Prospec
Page 58 and 59: RCVS-SAH (n=35) vs. aSAH (n=515)
Page 60 and 61: RCVS vs. PACNS
Page 63 and 64: Angio positive in 70 cases; biopsy
Page 65 and 66: RCVS vs PACNS: MGH cases, 1993-2009
Page 67 and 68: RCVS vs PACNS: MGH cases, 1993-2009
Page 69 and 70: Brain lesion topography in RCVS 3.
Page 71 and 72: Lesion patterns in PACNS 2. Diffuse
Page 73 and 74: Distinguishing RCVS from PACNS Clin
Page 75 and 76: Advanced MRI for Cerebral Arteriopa
Page 77 and 78: To study the phenomena of disease w
Page 79 and 80:
Illustrative Case 46 year male: acu
Page 81 and 82:
Illustrative Case MR angio - severe
Page 84 and 85:
PACNS - Typical Angiographic featur
Page 86:
Treatment vs Poor Outcome All Patie
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Reversible Cerebral Vasoconstriction Syndromes (RCVS)

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