Intra-arterial application of nimodipine in reversible cerebral vasoconstriction syndrome: A diagnostic tool in select cases?

Linn, Jennifer; Fesl, Gunther; Ottomeyer, Caroline; Straube, Andreas; Dichgans, Martin; Brückmann, H.; Pfefferkorn, Thomas

doi:10.1177/0333102410394673

Cited by 73 publications

(57 citation statements)

References 16 publications

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“…Additionally, DSA may provide complementary information to aid the diagnosis, including reversibility of vasoconstriction following intra-arterial administration of a vasodilator. [48][49][50][51][52] Because diagnostic confirmation of RCVS is usually retrospective following spontaneous resolution of clinical and angiographic findings in 1-3 months, there is often a substantial delay in confirming the diagnosis. Consequently, demonstration of reversibility following intra-arterial vasodilator administration can be clinically useful in the early recognition of RCVS, as opposed to the partial or incomplete improvement often seen with other vasospastic disorders.…”

Section: Catheter Angiographymentioning

confidence: 99%

“…Consequently, demonstration of reversibility following intra-arterial vasodilator administration can be clinically useful in the early recognition of RCVS, as opposed to the partial or incomplete improvement often seen with other vasospastic disorders. 52 At this time, the potential risks of such a diagnostic challenge remain uncertain and perhaps may be unnecessary if the clinical and radiologic findings are otherwise supportive of a diagnosis of RCVS.…”

Section: Catheter Angiographymentioning

confidence: 99%

“…Finally, improvement in cerebral artery narrowing following intra-arterial vasodilator therapy has also been proposed as a feature distinguishing RCVS from PACNS. 52 Cortical Vein Thrombosis. Cortical vein thrombosis is another potential cause of both thunderclap headache and convexity subarachnoid hemorrhage and should be considered in the differential diagnosis with RCVS in the appropriate clinical setting.…”

Section: 18mentioning

confidence: 99%

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Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis

Miller

Shivashankar

Mossa‐Basha

et al. 2015

AJNR Am J Neuroradiol

137

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SUMMARY:The diagnostic evaluation of a patient with reversible cerebral vasoconstriction syndrome integrates clinical, laboratory, and radiologic findings. Imaging plays an important role by confirming the presence of cerebral vasoconstriction; monitoring potential complications such as ischemic stroke; and suggesting alternative diagnoses, including CNS vasculitis and aneurysmal subarachnoid hemorrhage. Noninvasive vascular imaging, including transcranial Doppler sonography and MR angiography, has played an increasingly important role in this regard, though conventional angiography remains the criterion standard for the evaluation of cerebral artery vasoconstriction. Newer imaging techniques, including high-resolution vessel wall imaging, may help in the future to better discriminate reversible cerebral vasoconstriction syndrome from primary angiitis of the CNS, an important clinical distinction. ABBREVIATIONS:PACNS ϭ primary angiitis of the CNS; RCVS ϭ reversible cerebral vasoconstriction syndrome; TCD ϭ transcranial Doppler sonography; VWI ϭ

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Section: Catheter Angiographymentioning

confidence: 99%

Section: Catheter Angiographymentioning

confidence: 99%

Section: 18mentioning

confidence: 99%

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Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis

Miller

Shivashankar

Mossa‐Basha

et al. 2015

AJNR Am J Neuroradiol

137

View full text Add to dashboard Cite

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“…On the other hand, case reports have suggested a therapeutic role for calcium channel blockers and intra-arterial vasodilator infusions. [15][16][17] We designed this study to identify predictors and mechanisms of clinical and radiologic worsening in RCVS.…”

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confidence: 99%

Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome

2017

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Objective: Factors predicting poor outcome in patients with the reversible cerebral vasoconstriction syndrome (RCVS) have not been identified. Methods:In this single-center retrospective study, we analyzed the clinical, brain imaging, and angiography data in 162 patients with RCVS. Univariable and multivariable regression analysis were performed to identify predictors of persistent (nontransient) clinical worsening, radiologic worsening, early angiographic progression, and poor discharge outcome (modified Rankin Scale score 4-6).Results: The mean age was 44 6 13 years; 78% of patients were women. Persistent clinical worsening occurred in 14% at 6.6 6 4.1 days after symptom onset, radiologic worsening in 27% (mainly new infarcts), and angiographic progression in 15%. Clinical worsening correlated with angiographic progression and new nonhemorrhagic lesions. Age and sex did not independently predict any type of worsening. Infarction on baseline imaging predicted poor outcome. Prior serotonergic antidepressant use predicted clinical and angiographic worsening but not poor outcome. Intra-arterial vasodilator therapy independently predicted clinical worsening and poor discharge outcome but was offered to more severe cases. Glucocorticoid treatment proved to be an independent predictor of clinical, imaging, and angiographic worsening and poor outcome. Of the 23 patients with clinical worsening, 17 received glucocorticoids (15 within the preceding 2 days). There were no significant differences in baseline brain lesions and angiographic abnormalities between glucocorticoid-treated and untreated patients. Conclusion:Patients with RCVS at risk for worsening can be identified on basis of baseline features. Iatrogenic factors such as glucocorticoid exposure may contribute to worsening. Over the last decade, the clinical and imaging features of reversible cerebral vasoconstriction syndrome (RCVS) have been extensively characterized 1-7 and distinguished from its historic mimic, primary angiitis of the CNS (PACNS). [7][8][9] Patients with RCVS invariably present with recurrent severe thunderclap headaches. One-third to half develop ischemic and hemorrhagic brain lesions, either alone or in combination. Despite the dramatic onset and frequently ominous cerebral angiographic appearance, over 90% have excellent clinical outcome. 2,6 Yet studies that included a high proportion of inpatients have reported poor outcome (discharge modified Rankin Scale [mRS] score .3, including death) in 5%-14% of patients. 6,10 Factors predicting clinical outcome in RCVS have not been adequately identified. 10,11 We have reported an association between poor clinical outcome (mRS . 3) and glucocorticoid treatment, 6,7 which if confirmed has major clinical implications since glucocorticoids are frequently offered due to consideration of PACNS, a condition that warrants prompt initiation of long-term

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“…Intravenous prostacyclin is effective in one case report [60]. Intra-arterial nimodipine [61][62][63], verapamil [64] or the phosphodiesterase inhibitor milrinone [58] had been employed in some cases with refractory vasoconstrictions, with satisfactory outcomes. However, risk of reperfusion injury after intra-arterial intervention should be considered [55].…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Reversible cerebral vasoconstriction syndrome: current and future perspectives

Chen

Fuh

Wang

2011

Expert Review of Neurotherapeutics

135

145

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Intra-arterial application of nimodipine in reversible cerebral vasoconstriction syndrome: A diagnostic tool in select cases?

Abstract: Our preliminary results indicate that angiographic response to intra-arterial application might be a helpful differential diagnostic tool in select patients with suspected RCVS.

Cited by 73 publications

References 16 publications

Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis

Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis

Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome

Reversible cerebral vasoconstriction syndrome: current and future perspectives

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