Segmental Cerebral Arterial Constriction Associated with Pheochromocytoma

Armstrong, Frederick S.; Hayes, George J.

doi:10.3171/jns.1961.18.6.0843

Cited by 69 publications

(38 citation statements)

References 15 publications

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“…Heightened sympathetic activities are plausible with observations of SBP and triggers with elevated sympathetic tone in a great proportion of spontaneous RCVS patients [Ducros et al 2007;Chen et al 2006a]. In addition, evidence from secondary RCVS, such as patients with pheochromocytoma [Heo et al 2009;Im and Kim, 2008;Armstrong and Hayes, 1961], acute hypertensive crises [Tang-Wai et al 2001], or ingestion of sympathomimetic drugs [Kaye and Fainstat, 1987;Margolis and Newton, 1971], also support the significance of excessive sympathetic activity or an abnormal vascular response to circulating catecholamines. However, since the vasoconstrictions persist for a protracted course beyond headache resolution , there should be some factors regulating vascular tone other than heightened sympathetic activity participating in the pathogenesis.…”

Section: Dysfunctional Regulation Of Vascular Tonementioning

confidence: 88%

Reversible cerebral vasoconstriction syndrome: an under-recognized clinical emergency

Chen

Fuh

Wang

2010

Ther Adv Neurol Disord

116

118

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Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches and reversible cerebral vasoconstrictions. RCVS is more common than previously thought and should be differentiated from aneurismal subarachnoid hemorrhage. RCVS can be spontaneous or evoked by pregnancy or exposure to vasoactive substances. Patients tend to be middle-aged women but pediatric patients have been seen. Up to 80% of sufferers have identifiable triggers. Thunderclap headaches tend to recur daily and last for a period of around 2 weeks, while the vasoconstrictions may last for months. About one-third of patients have blood pressure surges accompanying headache attacks. The potential complications of RCVS include posterior reversible encephalopathy syndrome, ischemic strokes over watershed zones, cortical subarachnoid hemorrhage and intracerebral hemorrhage. Magnetic resonance images including angiography and venography and lumbar punctures are the studies of choice, whereas catheter angiography should not be implemented routinely. Patients with a mean flow velocity of the middle cerebral artery greater than 120 cm/s shown by transcranial color-coded sonography have a greater risk of ischemic complications than those without. The pathophysiology of RCVS remains unknown; sympathetic hyperactivity may play a role. Open-label trials showed calcium channel blockers, such as nimodipine may be an effective treatment in prevention of thunderclap headache attacks. In severe cases, intra-arterial therapy may be considered. Most patients with RCVS recover without sequelae; however, relapse has been reported in a small proportion of patients.

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Section: Dysfunctional Regulation Of Vascular Tonementioning

confidence: 88%

Reversible cerebral vasoconstriction syndrome: an under-recognized clinical emergency

Chen

Fuh

Wang

2010

Ther Adv Neurol Disord

116

118

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“…First, our case series closely resembles, clinically and angiographically, similar case studies that have been reported in association with other disorders linked to reversible vasoconstriction. These include vasculopathy in the postpartum period (15)(16)(17)(18), vasculopathy associated with pheochromocytoma (19), and that associated with the use of sympathomimetic drugs (20 -32). In each of these examples, the clinical picture is characterized by similar angiographic findings, benign spinal fluid, and a monophasic course.…”

Section: Discussionmentioning

confidence: 99%

Benign angiopathy of the central nervous system: Cohort of 16 patients with clinical course and long‐term followup

Hajj‐Ali

Furlan

Abou-Chebel

et al. 2002

Arthritis & Rheumatism

219

169

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Objective. Benign angiopathy of the central nervous system (BACNS) is a subset of primary angiitis of the central nervous system (PACNS) with favorable outcome, not requiring prolonged immunosuppression. We retrospectively studied the clinical characteristics and prospectively assessed long-term outcome in a cohort of BACNS patients. Methods. Patients meeting the clinical description for BACNS, evaluated and treated by a single investigator, were included. Data on demographics, signs and symptoms, laboratory studies, neuroimaging, brain biopsy, treatment, and complications were recorded. The long-term assessment included a phone interview utilizing the Barthel index and a specifically designed cognitive index. Results. Sixteen cases met the inclusion criteria. Mean age was 40 years (range 10 -66 years) with female:male ratio of 4.3:1 and a mean followup period of 35 months (0 -128 months). Headache was the most common presenting symptom, seen in 88% of the cases, followed by focal symptoms (63%), and diffuse symptoms (44%). All patients had highly abnormal cerebral angiography, and magnetic resonance imaging abnormalities were present in 77% (10 of 13). Severe cerebral spinal fluid (CSF) abnormalities were present in 1 patient (7%). All followup cerebral angiography showed marked improvement. Recovery was demonstrated in 94% of the patients, 6% relapsed, and there were no deaths. Of patients assessed by the Barthel index, 71% showed no disability and 29% had mild disability. Conclusion. There is a PACNS subset characterized by acute presentation (most commonly headache), normal to mildly abnormal CSF findings, female predominance, and highly abnormal cerebral angiography (reversible after treatment), requiring less intensive treatment than has been traditionally used.

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“…Ischemic stroke rarely occurs in patients with pheochromocytoma [1][2][3][4][5][6][7][8][9]. The present patient did not show any evidence of diseases associated with reversible cerebral angiopathy, moreover, the administration of an · 1 -blocker relieved the cerebral angiopathy and the ischemic attack prior to the resection of the pheochromocytoma.…”

mentioning

confidence: 64%

“…The present patient did not show any evidence of diseases associated with reversible cerebral angiopathy, moreover, the administration of an · 1 -blocker relieved the cerebral angiopathy and the ischemic attack prior to the resection of the pheochromocytoma. Some patients with pheochromocytoma have been reported to have cerebral angiopathy [1,3,8]. In those patients, angiopathy may be caused by vasospasm due to excessive levels of catecholamines.…”

mentioning

confidence: 99%

α-Blocker Is Effective in the Improvement of Cerebral Angiopathy in a Patient with Pheochromocytoma

et al. 2002

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Segmental Cerebral Arterial Constriction Associated with Pheochromocytoma

Cited by 69 publications

References 15 publications

Reversible cerebral vasoconstriction syndrome: an under-recognized clinical emergency

Reversible cerebral vasoconstriction syndrome: an under-recognized clinical emergency

Benign angiopathy of the central nervous system: Cohort of 16 patients with clinical course and long‐term followup

α-Blocker Is Effective in the Improvement of Cerebral Angiopathy in a Patient with Pheochromocytoma

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