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Shuujiun Wang - One of the best experts on this subject based on the ideXlab platform.
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reversible cerebral Vasoconstriction syndrome current and future perspectives
Expert Review of Neurotherapeutics, 2011Co-Authors: Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract:Reversible cerebral Vasoconstriction syndromes (RCVS) are characterized by recurrent acute severe headaches, namely thunderclap headaches, and multifocal segmental Vasoconstrictions. Interest has arisen in the definitions, clinical presentations, differential diagnoses, risk factors and complications of RCVS. This article will comprehensively review the milestone monographs and the latest research work addressing these issues. Studies that have focused on the relationship between RCVS and thunderclap headache will be detailed. We will also discuss research on the enigmatic pathophysiology and potential therapeutic approaches. Up-to-date information and challenges, undergoing studies and future research directions will be deeply probed.
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reversible cerebral Vasoconstriction syndrome an under recognized clinical emergency
Therapeutic Advances in Neurological Disorders, 2010Co-Authors: Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract: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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three paediatric patients with reversible cerebral Vasoconstriction syndromes
Cephalalgia, 2010Co-Authors: Hungyu Liu, Jiing-feng Lirng, Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract:Reversible cerebral Vasoconstriction syndromes (RCVS) occur predominantly in middle-aged women. Only one child with RCVS has ever been reported. We report three boys (aged 10, 16 and 10 years) who had multiple thunderclap headaches, including one boy with bath-related attacks. None of them had secondary causes. All their magnetic resonance angiography demonstrated reversible cerebral Vasoconstrictions of the major arteries with increased cerebral blood flow velocities on transcranial colour-coded sonography studies. Two of the three had hypertensive surges during headache attacks. None of the three boys had seizure, stroke or other neurological deficits. However, a left occipital subcortical lesion of unknown nature was noted in one boy. The efficacy of calcium channel blockers was variable in these three boys. This report suggests that, although rare, RCVS should be considered in paediatric patients if they present with a history of multiple attacks of thunderclap headache.
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magnetic resonance angiography in reversible cerebral Vasoconstriction syndromes
Annals of Neurology, 2009Co-Authors: Shihpin Chen, Jiing-feng Lirng, Shuujiun Wang, Jongling Fuh, Fengchi Chang, Ying Chen FangAbstract:Objective To investigate the evolution and clinical significance of Vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral Vasoconstriction syndromes (RCVS). Methods Patients with RCVS were recruited and followed up with MRA examinations until normalization of Vasoconstriction or for 6 months. The Vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0–<10%), 1 (10–<25%), 2 (25–<50%), 3 (50–<75%), and 4 (≥75%). Subjects with at least 1 segment with a Vasoconstriction score ≥2 were eligible for the study. Initial mean scores of single or combined arterial segments were used to predict ischemic complications. Results Seventy-seven patients with RCVS (8 men/69 women; average age 47.7 ± 11.6 years) finished the study with a total of 225 MRAs performed. The mean number of arterial segments involved was 5.3 ± 3.0 in the initial MRA. Vasoconstriction scores reached their maximum 16.3 ± 10.2 days after headache onset, close to the average timing of headache resolution (16.7 ± 8.6 days). Vasoconstriction evolved in a parallel trend among different arterial segments. Seven (9.1%) patients developed posterior reversible encephalopathy syndromes (PRES). Six (7.8%) patients had ischemic stroke. A logistic regression model demonstrated that the M1–P2 combined score was associated with highest risk of PRES (odds ratio [OR], 11.6, p = 0.005) and ischemic stroke (OR, 3.4; p = 0.026). Interpretation MRA evaluation in patients with RCVS is valid. Vasoconstriction was pervasive and outlasted headache resolution. Vasoconstrictions in M1 and P2 are important determinants for PRES and ischemic stroke. ANN NEUROL 2010;67:648–656
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Magnetic resonance angiography in reversible cerebral Vasoconstriction syndromes.
Annals of Neurology, 2009Co-Authors: Shihpin Chen, Jiing-feng Lirng, Shuujiun Wang, Jongling Fuh, Fengchi Chang, Ying Chen Fang, Ben Chang ShiaAbstract:Objective To investigate the evolution and clinical significance of Vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral Vasoconstriction syndromes (RCVS). Methods Patients with RCVS were recruited and followed up with MRA examinations until normalization of Vasoconstriction or for 6 months. The Vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0–
Jiing-feng Lirng - One of the best experts on this subject based on the ideXlab platform.
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three paediatric patients with reversible cerebral Vasoconstriction syndromes
Cephalalgia, 2010Co-Authors: Hungyu Liu, Jiing-feng Lirng, Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract:Reversible cerebral Vasoconstriction syndromes (RCVS) occur predominantly in middle-aged women. Only one child with RCVS has ever been reported. We report three boys (aged 10, 16 and 10 years) who had multiple thunderclap headaches, including one boy with bath-related attacks. None of them had secondary causes. All their magnetic resonance angiography demonstrated reversible cerebral Vasoconstrictions of the major arteries with increased cerebral blood flow velocities on transcranial colour-coded sonography studies. Two of the three had hypertensive surges during headache attacks. None of the three boys had seizure, stroke or other neurological deficits. However, a left occipital subcortical lesion of unknown nature was noted in one boy. The efficacy of calcium channel blockers was variable in these three boys. This report suggests that, although rare, RCVS should be considered in paediatric patients if they present with a history of multiple attacks of thunderclap headache.
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magnetic resonance angiography in reversible cerebral Vasoconstriction syndromes
Annals of Neurology, 2009Co-Authors: Shihpin Chen, Jiing-feng Lirng, Shuujiun Wang, Jongling Fuh, Fengchi Chang, Ying Chen FangAbstract:Objective To investigate the evolution and clinical significance of Vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral Vasoconstriction syndromes (RCVS). Methods Patients with RCVS were recruited and followed up with MRA examinations until normalization of Vasoconstriction or for 6 months. The Vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0–<10%), 1 (10–<25%), 2 (25–<50%), 3 (50–<75%), and 4 (≥75%). Subjects with at least 1 segment with a Vasoconstriction score ≥2 were eligible for the study. Initial mean scores of single or combined arterial segments were used to predict ischemic complications. Results Seventy-seven patients with RCVS (8 men/69 women; average age 47.7 ± 11.6 years) finished the study with a total of 225 MRAs performed. The mean number of arterial segments involved was 5.3 ± 3.0 in the initial MRA. Vasoconstriction scores reached their maximum 16.3 ± 10.2 days after headache onset, close to the average timing of headache resolution (16.7 ± 8.6 days). Vasoconstriction evolved in a parallel trend among different arterial segments. Seven (9.1%) patients developed posterior reversible encephalopathy syndromes (PRES). Six (7.8%) patients had ischemic stroke. A logistic regression model demonstrated that the M1–P2 combined score was associated with highest risk of PRES (odds ratio [OR], 11.6, p = 0.005) and ischemic stroke (OR, 3.4; p = 0.026). Interpretation MRA evaluation in patients with RCVS is valid. Vasoconstriction was pervasive and outlasted headache resolution. Vasoconstrictions in M1 and P2 are important determinants for PRES and ischemic stroke. ANN NEUROL 2010;67:648–656
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Magnetic resonance angiography in reversible cerebral Vasoconstriction syndromes.
Annals of Neurology, 2009Co-Authors: Shihpin Chen, Jiing-feng Lirng, Shuujiun Wang, Jongling Fuh, Fengchi Chang, Ying Chen Fang, Ben Chang ShiaAbstract:Objective To investigate the evolution and clinical significance of Vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral Vasoconstriction syndromes (RCVS). Methods Patients with RCVS were recruited and followed up with MRA examinations until normalization of Vasoconstriction or for 6 months. The Vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0–
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transcranial color doppler study for reversible cerebral Vasoconstriction syndromes
Annals of Neurology, 2008Co-Authors: Shihpin Chen, Jiing-feng Lirng, Shuujiun Wang, Jongling Fuh, Fengchi Chang, Ben Chang ShiaAbstract:Objective Reversible cerebral Vasoconstriction syndromes (RCVS) are characterized by thunderclap headaches and reversible cerebral Vasoconstrictions. No systematic studies on cerebral hemodynamics have been published. Methods Patients with RCVS were consecutively recruited. Sequential transcranial color-coded sonography studies were performed on the middle cerebral artery (MCA) for 3 months. Mean flow velocities (VMCA) and Lindegaard Index (LI) were recorded and compared with those of controls. Results Thirty-two patients (all female; average age, 49.7 ± 6.8 years) were enrolled. Four developed of reversible posterior leukoencephalopathy syndrome, and two of them, ischemic strokes. One hundred and twenty-six sonography studies were performed on 57 eligible MCAs. The mean maximum VMCA (109.5 ± 30.8cm/sec) and LI (2.2 ± 0.7) of RCVS patients exceeded those of controls (VMCA: 66.3 ± 9.5cm/sec, p < 0.001; LI: 1.4 ± 0.3, p < 0.001). The VMCA and LI levels were still at their plateau at the mean time (day 22 after headache onset) of headache resolution. Fifteen (46.9%) patients had VMCA exceeding 120cm/sec, and 5 (16%) had LI exceeding 3. Patients fulfilling the criteria of subarachnoid hemorrhage mild vasospasm (n = 4; 13%), that is, both VMCA greater than 120cm/sec and LI greater than 3, had a greater risk of posterior leukoencephalopathy (75 vs 4%; p = 0.003) and ischemic strokes (50 vs 0%; p = 0.01) than those without. Interpretation Patients with RCVS experienced prolonged Vasoconstriction, making the risk for posterior leukoencephalopathy and ischemic strokes outlast headache resolution. Patients fulfilling mild vasospasm criteria for subarachnoid hemorrhage carry a high risk. Ann Neurol 2008
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bath related thunderclap headache a study of 21 consecutive patients
Cephalalgia, 2008Co-Authors: Shuujiun Wang, Zinan Wu, Jiing-feng Lirng, Shihpin ChenAbstract:We consecutively recruited 21 patients (all women, mean 54 ± 8 years) with bath-related thunderclap headache (BRTH). Thirteen of them were in menopause, two had just ceased hormonal therapy, and one was at 3 months postpartum. Bathing was the initial trigger for thunderclap headaches in nine patients (43%). Many patients (n = 15, 71%) had other non-bath-related attacks. Most patients (n = 18, 86%) reported that the headache occurred immediately when water was sprayed over their body, with warm water (52%) as the most common. During the disease course [mean 14 days (6–34)], the mean number of BRTH was 5.1 ± 3.6 attacks. Nineteen patients (90%) changed bathing habits to prevent attacks. Thirteen patients (62%) had magnetic resonance angiography Vasoconstrictions, and two of them (15%) developed reversible posterior encephalopathy. None of the patients without Vasoconstrictions had this complication. Nimodipine was effective in stopping further attacks in 84% (16/19) treated patients. No relapse was reported at a mean follow-up of 30 months. BRTH occurred exclusively in women and predominantly in middle age. Deficiency or fluctuation of female sex hormones may play a role. About 60% patients showed cerebral vasospasms, fulfilling the diagnosis of reversible cerebral Vasoconstriction syndrome and indicating a risk of posterior encephalopathy.
Shihpin Chen - One of the best experts on this subject based on the ideXlab platform.
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reversible cerebral Vasoconstriction syndrome current and future perspectives
Expert Review of Neurotherapeutics, 2011Co-Authors: Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract:Reversible cerebral Vasoconstriction syndromes (RCVS) are characterized by recurrent acute severe headaches, namely thunderclap headaches, and multifocal segmental Vasoconstrictions. Interest has arisen in the definitions, clinical presentations, differential diagnoses, risk factors and complications of RCVS. This article will comprehensively review the milestone monographs and the latest research work addressing these issues. Studies that have focused on the relationship between RCVS and thunderclap headache will be detailed. We will also discuss research on the enigmatic pathophysiology and potential therapeutic approaches. Up-to-date information and challenges, undergoing studies and future research directions will be deeply probed.
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reversible cerebral Vasoconstriction syndrome an under recognized clinical emergency
Therapeutic Advances in Neurological Disorders, 2010Co-Authors: Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract: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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three paediatric patients with reversible cerebral Vasoconstriction syndromes
Cephalalgia, 2010Co-Authors: Hungyu Liu, Jiing-feng Lirng, Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract:Reversible cerebral Vasoconstriction syndromes (RCVS) occur predominantly in middle-aged women. Only one child with RCVS has ever been reported. We report three boys (aged 10, 16 and 10 years) who had multiple thunderclap headaches, including one boy with bath-related attacks. None of them had secondary causes. All their magnetic resonance angiography demonstrated reversible cerebral Vasoconstrictions of the major arteries with increased cerebral blood flow velocities on transcranial colour-coded sonography studies. Two of the three had hypertensive surges during headache attacks. None of the three boys had seizure, stroke or other neurological deficits. However, a left occipital subcortical lesion of unknown nature was noted in one boy. The efficacy of calcium channel blockers was variable in these three boys. This report suggests that, although rare, RCVS should be considered in paediatric patients if they present with a history of multiple attacks of thunderclap headache.
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magnetic resonance angiography in reversible cerebral Vasoconstriction syndromes
Annals of Neurology, 2009Co-Authors: Shihpin Chen, Jiing-feng Lirng, Shuujiun Wang, Jongling Fuh, Fengchi Chang, Ying Chen FangAbstract:Objective To investigate the evolution and clinical significance of Vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral Vasoconstriction syndromes (RCVS). Methods Patients with RCVS were recruited and followed up with MRA examinations until normalization of Vasoconstriction or for 6 months. The Vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0–<10%), 1 (10–<25%), 2 (25–<50%), 3 (50–<75%), and 4 (≥75%). Subjects with at least 1 segment with a Vasoconstriction score ≥2 were eligible for the study. Initial mean scores of single or combined arterial segments were used to predict ischemic complications. Results Seventy-seven patients with RCVS (8 men/69 women; average age 47.7 ± 11.6 years) finished the study with a total of 225 MRAs performed. The mean number of arterial segments involved was 5.3 ± 3.0 in the initial MRA. Vasoconstriction scores reached their maximum 16.3 ± 10.2 days after headache onset, close to the average timing of headache resolution (16.7 ± 8.6 days). Vasoconstriction evolved in a parallel trend among different arterial segments. Seven (9.1%) patients developed posterior reversible encephalopathy syndromes (PRES). Six (7.8%) patients had ischemic stroke. A logistic regression model demonstrated that the M1–P2 combined score was associated with highest risk of PRES (odds ratio [OR], 11.6, p = 0.005) and ischemic stroke (OR, 3.4; p = 0.026). Interpretation MRA evaluation in patients with RCVS is valid. Vasoconstriction was pervasive and outlasted headache resolution. Vasoconstrictions in M1 and P2 are important determinants for PRES and ischemic stroke. ANN NEUROL 2010;67:648–656
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Magnetic resonance angiography in reversible cerebral Vasoconstriction syndromes.
Annals of Neurology, 2009Co-Authors: Shihpin Chen, Jiing-feng Lirng, Shuujiun Wang, Jongling Fuh, Fengchi Chang, Ying Chen Fang, Ben Chang ShiaAbstract:Objective To investigate the evolution and clinical significance of Vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral Vasoconstriction syndromes (RCVS). Methods Patients with RCVS were recruited and followed up with MRA examinations until normalization of Vasoconstriction or for 6 months. The Vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0–
Jongling Fuh - One of the best experts on this subject based on the ideXlab platform.
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reversible cerebral Vasoconstriction syndrome current and future perspectives
Expert Review of Neurotherapeutics, 2011Co-Authors: Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract:Reversible cerebral Vasoconstriction syndromes (RCVS) are characterized by recurrent acute severe headaches, namely thunderclap headaches, and multifocal segmental Vasoconstrictions. Interest has arisen in the definitions, clinical presentations, differential diagnoses, risk factors and complications of RCVS. This article will comprehensively review the milestone monographs and the latest research work addressing these issues. Studies that have focused on the relationship between RCVS and thunderclap headache will be detailed. We will also discuss research on the enigmatic pathophysiology and potential therapeutic approaches. Up-to-date information and challenges, undergoing studies and future research directions will be deeply probed.
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reversible cerebral Vasoconstriction syndrome an under recognized clinical emergency
Therapeutic Advances in Neurological Disorders, 2010Co-Authors: Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract: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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three paediatric patients with reversible cerebral Vasoconstriction syndromes
Cephalalgia, 2010Co-Authors: Hungyu Liu, Jiing-feng Lirng, Shihpin Chen, Jongling Fuh, Shuujiun WangAbstract:Reversible cerebral Vasoconstriction syndromes (RCVS) occur predominantly in middle-aged women. Only one child with RCVS has ever been reported. We report three boys (aged 10, 16 and 10 years) who had multiple thunderclap headaches, including one boy with bath-related attacks. None of them had secondary causes. All their magnetic resonance angiography demonstrated reversible cerebral Vasoconstrictions of the major arteries with increased cerebral blood flow velocities on transcranial colour-coded sonography studies. Two of the three had hypertensive surges during headache attacks. None of the three boys had seizure, stroke or other neurological deficits. However, a left occipital subcortical lesion of unknown nature was noted in one boy. The efficacy of calcium channel blockers was variable in these three boys. This report suggests that, although rare, RCVS should be considered in paediatric patients if they present with a history of multiple attacks of thunderclap headache.
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magnetic resonance angiography in reversible cerebral Vasoconstriction syndromes
Annals of Neurology, 2009Co-Authors: Shihpin Chen, Jiing-feng Lirng, Shuujiun Wang, Jongling Fuh, Fengchi Chang, Ying Chen FangAbstract:Objective To investigate the evolution and clinical significance of Vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral Vasoconstriction syndromes (RCVS). Methods Patients with RCVS were recruited and followed up with MRA examinations until normalization of Vasoconstriction or for 6 months. The Vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0–<10%), 1 (10–<25%), 2 (25–<50%), 3 (50–<75%), and 4 (≥75%). Subjects with at least 1 segment with a Vasoconstriction score ≥2 were eligible for the study. Initial mean scores of single or combined arterial segments were used to predict ischemic complications. Results Seventy-seven patients with RCVS (8 men/69 women; average age 47.7 ± 11.6 years) finished the study with a total of 225 MRAs performed. The mean number of arterial segments involved was 5.3 ± 3.0 in the initial MRA. Vasoconstriction scores reached their maximum 16.3 ± 10.2 days after headache onset, close to the average timing of headache resolution (16.7 ± 8.6 days). Vasoconstriction evolved in a parallel trend among different arterial segments. Seven (9.1%) patients developed posterior reversible encephalopathy syndromes (PRES). Six (7.8%) patients had ischemic stroke. A logistic regression model demonstrated that the M1–P2 combined score was associated with highest risk of PRES (odds ratio [OR], 11.6, p = 0.005) and ischemic stroke (OR, 3.4; p = 0.026). Interpretation MRA evaluation in patients with RCVS is valid. Vasoconstriction was pervasive and outlasted headache resolution. Vasoconstrictions in M1 and P2 are important determinants for PRES and ischemic stroke. ANN NEUROL 2010;67:648–656
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Magnetic resonance angiography in reversible cerebral Vasoconstriction syndromes.
Annals of Neurology, 2009Co-Authors: Shihpin Chen, Jiing-feng Lirng, Shuujiun Wang, Jongling Fuh, Fengchi Chang, Ying Chen Fang, Ben Chang ShiaAbstract:Objective To investigate the evolution and clinical significance of Vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral Vasoconstriction syndromes (RCVS). Methods Patients with RCVS were recruited and followed up with MRA examinations until normalization of Vasoconstriction or for 6 months. The Vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0–
Dheeraj Gandhi - One of the best experts on this subject based on the ideXlab platform.
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reversible cerebral Vasoconstriction syndrome part 2 diagnostic work up imaging evaluation and differential diagnosis
American Journal of Neuroradiology, 2015Co-Authors: Timothy R Miller, Ravishankar Shivashankar, Mahmud Mossabasha, Dheeraj GandhiAbstract: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.
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reversible cerebral Vasoconstriction syndrome part 1 epidemiology pathogenesis and clinical course
American Journal of Neuroradiology, 2015Co-Authors: Timothy R Miller, Ravishankar Shivashankar, Mahmud Mossabasha, Dheeraj GandhiAbstract:SUMMARY: Reversible cerebral Vasoconstriction syndrome is a clinical and radiologic syndrome that represents a common presentation of a diverse group of disorders. The syndrome is characterized by thunderclap headache and reversible Vasoconstriction of cerebral arteries, which can either be spontaneous or related to an exogenous trigger. The pathophysiology of reversible cerebral Vasoconstriction syndrome is unknown, though alterations in cerebral vascular tone are thought to be a key underlying mechanism. The syndrome typically follows a benign course; however, reversible cerebral Vasoconstriction syndrome may result in permanent disability or death in a small minority of patients secondary to complications such as ischemic stroke or intracranial hemorrhage.
