Reversible Cerebral Vasoconstriction Syndromes (RCVS)
Reversible Cerebral Vasoconstriction Syndromes (RCVS)
Reversible Cerebral Vasoconstriction Syndromes (RCVS)
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Hypothesis<br />
• Raphe nuclei in the brainstem, projections to<br />
peri-vascular nerves<br />
– trigeminovascular system and serotonergic pathways<br />
• Increased serotonin, NE levels in nerve endings<br />
• Might explain the headache, hyper-reflexia,<br />
segmental vasoconstriction, depression in <strong>RCVS</strong><br />
• Distal capillary bed - serotonergic effects may<br />
explain edema, overlap with PRES<br />
• In addition, endothelial dysfunction might be<br />
related to vasoconstriction in <strong>RCVS</strong>-PRES?<br />
– soluble anti-angiogenic factors (sFlt1, endoglin)<br />
• (Levin et al. NEJM 2004, 2006; Singhal et al, NEJM 2009)
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