Pathophysiology of reversible cerebral vasoconstriction syndrome

Chen, Wei–Ta; Wang, Shuu Jiun

doi:10.1186/s12929-022-00857-4

Cited by 43 publications

(52 citation statements)

References 126 publications

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“…This relationship may be supported by the effects of COVID -19 on the vascular endothelium [ 124 ], with the impairment of cerebral autoregulatory mechanisms representing the pathophysiological process of both RCVS and PRES [ 17 , 21 ]. Some studies reported that SARS-CoV2 may enter the CNS [ 125 , 126 ] and exert its effects on the endothelium [ 124 ], while others demonstrated that it binds to the angiotensin-converting enzyme 2 (ACE2) receptor, which is highly expressed in neurons and glial cells [ 125 ].…”

Section: Discussionmentioning

confidence: 99%

“…Key elements are focal vasoconstrictions of brain vessels, which appear in angiographic studies as intermittent focal narrowing, causing the “sausage on a string appearance”. A proposed model suggests that the disease may be caused by an interplay of endothelial dysfunction, oxidative stress, and sympathetic overactivity which results in BBB disruption and cerebral vascular tone dysregulation [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome in patients with COVID-19 infection: is there a link? A systematic review and case report analysis

et al. 2023

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During the SARS-CoV2 pandemic, several cases of Posterior Reversible Encephalopathy Syndrome (PRES) and of Reversible Cerebral Vasoconstriction Syndrome (RCVS) in COVID-19 patients have been reported, but the link between these syndromes and COVID-19 is unclear. We performed a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to evaluate whether SARS-CoV2 infection or the drugs used to treat it could be deemed potential risk factors for PRES or RCVS. We performed a literature search. We found 70 articles (60 on PRES and 10 on RCVS) concerning n = 105 patients (n = 85 with PRES, n = 20 with RCVS). We analyzed the clinical characteristics of the two populations separately, then performed an inferential analysis to search for other independent risk factors. We found fewer than usual PRES-related (43.9%) and RCVS-related (45%) risk factors in patients with COVID-19. Such a low incidence of risk factors for PRES and RCVS might suggest the involvement of COVID-19 as an additional risk factor for both diseases due to its capability to cause endothelial dysfunction. We discuss the putative mechanisms of endothelial damage by SARS-CoV2 and antiviral drugs which may underlie the development of PRES and RCVS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome in patients with COVID-19 infection: is there a link? A systematic review and case report analysis

et al. 2023

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“…The sympathetic system around the vessels has been proposed to be responsible for the abrupt onset of both headache and vasospasm in patients with thunderclap headache (64). Vasospasm, which refers to a reversible process of a localized smooth muscle contraction of the blood vessel walls resulting in segmental luminal narrowing, can be an expression of high sympathetic tone (65–67). However, vasospasm only appears in RCVS but not in primary thunderclap headache.…”

Section: Pathophysiologymentioning

confidence: 99%

Update on primary headache associated with sexual activity and primary thunderclap headache

Lin

Chen

2023

Cephalalgia

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Background This narrative review aims to provide an update on primary headache associated with sexual activity and primary thunderclap headache. Methods We conducted a literature search on PubMed with the keywords “headache associated with sexual activity”, “sexual headache”, “orgasmic cephalalgia”, and “coital cephalalgia” in addition to “thunderclap headache” to assess the appropriateness of all published articles in this review. Results Primary headache associated with sexual activity is a “primary” headache precipitated by sexual activity, which occurs as sexual excitement increases (progressive at onset), or manifests as an abrupt and intense headache upon orgasm (thunderclap at onset) or combines these above two features. Primary headache associated with sexual activity is diagnosed after a thorough investigation, including appropriate neuroimaging studies, to exclude life-threatening secondary causes such as subarachnoid hemorrhage. According to the criteria of the third edition of the International Classification of Headache Disorders, primary thunderclap headache is also a diagnosis by exclusion. The pathophysiology of primary headache associated with sexual activity and primary thunderclap headache remains incompletely understood. Treatment may not be necessary for all patients since some patients with primary headache associated with sexual activity and primary thunderclap headache have a self-limiting course. Conclusion A comprehensive neuroimaging study is needed for distinguishing primary headache associated with sexual activity or primary thunderclap headache from secondary causes. Primary headache associated with sexual activity and primary thunderclap headache are self-limited diseases and the prognoses are good, but some patients with primary headache associated with sexual activity may have a prolonged course.

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“…2 As cerebral arteries are densely innervated, the release of norepinephrine or neuropeptide Y from the sympathetic nerve endings may cause vasoconstrictions. 3 Angiographically, SAH-induced vasospasm is more commonly long-segmental and mainly around the bleeding focus, compared with the multiple, short-segmental, and diffuse changes seen in RCVS. 4 However, by analogy, RCVS is treated by nimodipine, and in some rare cases, the use of milrinone might be considered.…”

mentioning

confidence: 99%

“…4 However, by analogy, RCVS is treated by nimodipine, and in some rare cases, the use of milrinone might be considered. 3…”

mentioning

confidence: 99%

Reversible Cerebral Vasoconstriction Syndrome Treated by Continuous Intravenous Milrinone

Malleray

Gazzola

Meaudre

et al. 2023

J Neuroanaesth Crit Care

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Pathophysiology of reversible cerebral vasoconstriction syndrome

Cited by 43 publications

References 126 publications

Posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome in patients with COVID-19 infection: is there a link? A systematic review and case report analysis

Posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome in patients with COVID-19 infection: is there a link? A systematic review and case report analysis

Update on primary headache associated with sexual activity and primary thunderclap headache

Reversible Cerebral Vasoconstriction Syndrome Treated by Continuous Intravenous Milrinone

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