Reversible cerebral angiopathy

Zuber, Mathieu; Touzé, Emmanuel; Domigo, Valérie; Trystram, Denis; Lamy, Catherine; Mas, Jean‐Louis

doi:10.1007/s00415-006-0269-x

Cited by 44 publications

(28 citation statements)

References 12 publications

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“…While on nimodipine, four patients had transient ischemic attack and one patient had multiple cerebral infarcts. Contrasting with the previously published experience of positive effects of nimodipine, these results suggest that nimodipine needs to be evaluated in a placebo-controlled study [32,33].…”

Section: Treatmentcontrasting

confidence: 82%

Reversible Cerebral Vasospasm, Multilobular Intracerebral Hemorrhages, and Nonaneurysmal Subarachnoid Hemorrhage: Review of Possible Interrelationships

Hantson

Forget

2010

Curr Pain Headache Rep

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"Reversible cerebral vasoconstriction syndrome" (RCVS) is a recently described entity that is mainly characterized by the association of severe ("thunderclap") headaches with or without additional neurological symptoms and diffuse, multifocal, segmental narrowings involving large and medium-sized cerebral arteries. By definition, angiographic abnormalities disappear within 3 months. The clinical course is usually benign, with a higher prevalence in young women. RCVS is idiopathic in the majority of the cases. However, recent papers have outlined the role of precipitating factors, including the use of vasoactive substances. Some patients, nevertheless, have a more severe clinical course with transient or permanent ischemic events. Hemorrhagic complications appear to have been underestimated. They are usually restricted to circumscribed cortical subarachnoid hemorrhage, in the absence of any ruptured cerebral aneurysm. This limited bleeding is unlikely at the origin of the diffuse vasoconstriction. The finding of an unruptured cerebral aneurysm in RCVS patients is probably incidental. An overlap is possible between RCVS and other syndromes such as posterior reversible encephalopathy syndrome. There is no standardized treatment regimen for RCVS patients. It appears rational to further investigate the efficacy and safety of the calcium-channel antagonist nimodipine.

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Section: Treatmentcontrasting

confidence: 82%

Reversible Cerebral Vasospasm, Multilobular Intracerebral Hemorrhages, and Nonaneurysmal Subarachnoid Hemorrhage: Review of Possible Interrelationships

Hantson

Forget

2010

Curr Pain Headache Rep

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“…However, it is not clear how lesions can be prevented or whether vasoconstriction monitoring has any use. Although some case series suggest benefit with nimodipine, 19 other studies have not shown therapeutic benefit with calcium-channel blocker therapy. 4,16 The risk of developing new brain lesions seems substantial (5 of 19 patients) in patients with ICH and relatively low (5 of 56 patients) in those with cSAH on initial imaging.…”

Section: Strokementioning

confidence: 99%

Hemorrhagic Reversible Cerebral Vasoconstriction Syndrome

Topçuoğlu

Singhal

2016

Stroke

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Background and Purpose-To compare hemorrhagic and nonhemorrhagic reversible cerebral vasoconstriction syndromes (RCVS) with a view to understand mechanisms. Methods-This single-center retrospective study included 162 patients with RCVS. Clinical, brain imaging, and angiography data were analyzed. Results-The mean age was 44±13 years, 78% women. Hemorrhages occurred in 43% including 21 patients with intracerebral hemorrhage (ICH) and 62 with convexal subarachnoid hemorrhage (cSAH). The frequency of triggers (eg, vasoconstrictive drugs) and risk factors (eg, migraine) were not significantly different between hemorrhagic and nonhemorrhagic RCVS or between subgroups (ICH versus non-ICH, isolated cSAH versus normal scan). Hemorrhagic lesions occurred within the first week, whereas infarcts and vasogenic edema accumulated during 2 to 3 weeks (P<0.001). Although all ICHs occurred before cSAH, their time course was not significantly different (P=0.11). ICH and cSAH occurred earlier than infarcts (P≤0.001), and ICH earlier than vasogenic edema (P=0.009).Angiogram analysis showed more severe vasoconstriction in distal versus proximal segments in all lesion types (ICH, cSAH, infarction, vasogenic edema, and normal scan). The isolated infarction group had more severe proximal vasoconstriction, and those with normal imaging had significantly less vasoconstriction. Multivariable analysis failed to uncover independent predictors of hemorrhagic RCVS; however, female sex predicted ICH (P=0.048), and angiographic severity predicted infarction (P=0.043). Conclusions-ICH and cSAH are common complications of RCVS. Triggers and risk factors do not predict lesion subtype but may alter central vasomotor control mechanisms resulting in centripetal angiographic evolution. Early distal vasoconstriction is associated with lobar ICH and cSAH, and delayed proximal vasoconstriction with infarction.

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“…In a few randomized, controlled studies of approximately 8-to 16-weeks' duration, oral nimodipine 120 mg daily in divided doses reduced the frequency and possibly the severity and duration of migraine attacks in patients with classic or common migraine (140)(141)(142)(143)(144). In general, benefit was observed within 1-2 months after beginning of treatment (141,(145)(146)(147)(148)(149).…”

Section: Migrainementioning

confidence: 88%

Nimodipine and Its Use in Cerebrovascular Disease: Evidence from Recent Preclinical and Controlled Clinical Studies

Tomassoni

Lanari

Silvestrelli

et al. 2008

Clinical and Experimental Hypertension

122

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Nimodipine is a 1,4-dihydropyridine-derivative Ca(2+)-channel blocker developed approximately 30 years ago. It is highly lipophilic, crosses the blood-brain barrier, and reaches brain and cerebrospinal fluid. Early treatment with nimodipine reduces the severity of neurological deficits resulting from vasospasm in subarachnoid haemorrhage (SAH) patients. In SAH, nimodipine reduced spasm-related deficits of all severities, but no spasm-unrelated deficits. This paper has reviewed preclinical studies on the influence of nimodipine in various animal models of cerebral ischemia, with particular attention toward investigations published in the last 10 years. These studies further support the main indication of nimodipine, by clarifying some mechanisms of the anti-ischemic activity of the compound. Papers reporting a possible role of nimodipine in epileptogenesis were also examined. Clinical studies on nimodipine were grouped into subarachnoid hemorrhage, acute ischemic stroke, cerebral ischemia without stroke, dementia disorders, and migraine. Clinical investigations have shown that the drug improves neurological outcome by reducing the incidence and severity of ischemic deficits in patients with SAH from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition. No relevant effects of treatment with nimodipine were reported for acute ischemic stroke, cerebral ischemia without stroke, and migraine, except than for cluster headache. The less pronounced cardiovascular effects of nimodipine compared to other dihydropyridine-type Ca(2+)-channel blockers probably accounts for its use out of label for treating patients affected by chronic cerebral ischemia and vascular cognitive impairment. However, the blood pressure-lowering effects of nimodipine should not be minimized, as clinical studies have documented lowering blood pressure in small groups of patients, including cases of withdrawn due to pronounced hypotension induced by nimodipine administration. In the area of vascular cognitive impairment, short-term benefits of nimodipine do not justify its use as a long-term anti-dementia drug, and benefits obtained in elderly patients affected by subcortical vascular dementia require to be confirmed by other groups and in larger scale trials. In conclusion, nimodipine is a safe drug with an important place in pharmacotherapy and with the main documentation for reduction in the severity of neurological deficits resulting from vasospasm in SAH patients.

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Reversible cerebral angiopathy

Abstract: Reversible cerebral angiopathy (RCA) is responsible for disabling headache and potential stroke complications. Most patients respond poorly to analgesics. We describe four patients with typical RCA whose headache rapidly disappeared after IV nimodipine treatment was initiated.

Cited by 44 publications

References 12 publications

Reversible Cerebral Vasospasm, Multilobular Intracerebral Hemorrhages, and Nonaneurysmal Subarachnoid Hemorrhage: Review of Possible Interrelationships

Reversible Cerebral Vasospasm, Multilobular Intracerebral Hemorrhages, and Nonaneurysmal Subarachnoid Hemorrhage: Review of Possible Interrelationships

Hemorrhagic Reversible Cerebral Vasoconstriction Syndrome

Nimodipine and Its Use in Cerebrovascular Disease: Evidence from Recent Preclinical and Controlled Clinical Studies

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