Reversible Cerebral Vasoconstriction Syndromes (RCVS)

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Stroke attributed to ‘vasospasm’ for centuries 1950s: Pathological entities - Carotid athero - Atrial fibrillation - Lacunar ‘Vasospasm’ not implicated - except SAH - except rare migraine 1971, 1975: Salpetrierre Conf. 1988: Call-Fleming Syndrome C. Miller Fisher, MD
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 28 and 29: RCVS • Group of conditions charac
Page 32: M. Akif Topcuoglu, MD (circa 2002)
Page 37 and 38: Additional Slides - Pathophysiology
Page 39 and 40: Pathophysiology of RCVS - ‘migrai
Page 41 and 42: TCD response to Apnea (breath-hold)
Page 43 and 44: Perivascular Nerves • Perivascula
Page 45 and 46: Hypothesis • Raphe nuclei in the
Page 47 and 48: Inter-relationship between RCVS & P
Page 49 and 50: RCVS and serotonergic drugs Drugs a
Page 51 and 52: Serotonin - further evidence • SS
Page 53 and 54: RCVS and Migraine
Page 55 and 56: Other Headaches and ‘Vasospasm’
Page 57 and 58: RCVS vs. aSAH
Page 59 and 60: RCVS (n=35) vs. aSAH (n=515) • RC
Page 61: RCVS versus PACNS • 1950s: Primar
Page 64 and 65: RCVS vs PACNS: MGH cases, 1993-2009
Page 66 and 67: RCVS vs PACNS: MGH cases, 1993-2009
Page 68 and 69: Brain Lesion Topography in RCVS 1.
Page 70 and 71: Lesion patterns in PACNS 1. Punctat
Page 72 and 73: Lesion patterns in PACNS 3. Single,
Page 74 and 75: Comparison of CTA and DSA Findings
Page 76 and 77: A B C D E Brain biopsy positive PA
Page 78 and 79: Cerebral Arteriopathies 1. Large or
Page 80 and 81:
Illustrative Case Recurrent 10/10
Page 82:
Illustrative Case # 2 57 y woman. R
Page 85 and 86:
RCVS - Typical Angiographic feature
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Reversible Cerebral Vasoconstriction Syndromes (RCVS)

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