Reversible Cerebral Vasoconstriction Syndrome: A Comprehensive Systematic Review

Song, Tae-Jin and Lee, Keum Hwa and Li, Han and Kim, Jung Yoon and Chang, Kathleen and Kim, Seong Heon and Han, Kyoung Hee and Kim, Bo Yi and Kronbichler, Andreas and Ducros, Anne and Koyanagi, Ai and Jacob, Louis and Kim, Min Seo and Yon, Dong Keon and Lee, Seung Won and Yang, Jee Myung and Hong, Sung Hwi and Ghayda, Ramy A. and Kang, Joon Won and Shin, Jae Il and Smith, Lee (2021) Reversible Cerebral Vasoconstriction Syndrome: A Comprehensive Systematic Review. European Review for Medical and Pharmacological Sciences, 25 (9). pp. 3519-3529. ISSN 2284-0729

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OBJECTIVE: We aimed to analyze clinical characteristics, treatment patterns, and prognosis of patients with reversible cerebral vasoconstriction syndrome (RCVS). MATERIALS AND METHODS: Two investigators independently searched PubMed and EMBASE, and 191 cases were included in this study. Information regarding demographics, triggering factors, brain imaging findings, treatment modalities, recurrence, and clinical outcome was collected. RESULTS: The mean age of the patients was 39.9 years, and 155 (81.2%) were female. The most common triggering factor for RCVS was an exposure to vasoactive substances (41.4%), followed by pregnancy/postpartum (20.9%), and sexual intercourse (10.5%). Multifocal stenosis (84.0%) and beading shape (82.4%) were the leading abnormal findings on angiography, while cerebral ischemic lesions (47.6%) and cerebral hemorrhage (mainly subarachnoid hemorrhage) (35.1%) were the main findings on brain computed tomography (CT)/magnetic resonance imaging (MRI). Calcium channel blockers (nimodipine/verapamil) were the most commonly used medications (44.5%) in the treatment of RCVS. Multivariate analysis identified that RCVS was precipitated by trauma/surgery/procedure (hazard ratio (HR): 3.29, 95% confidence interval (CI) (1.21-8.88), p=0.019), and presence of aphasia/neglect/apraxia during the acute phase of the disease (HR: 3.83, 95% CI (1.33-11.05), p=0.013) were found to be the two independent risk factors for residual neurological deficit after RCVS. CONCLUSIONS: In our systematic review, vasoactive substances were the most frequent triggers for RCVS, which was most commonly accompanied by angiographic findings of multifocal stenotic lesions. Patients with RCVS precipitated by trauma or surgical procedures and those with focal cortical deficits had a higher risk of residual neurological deficits, and these patients should closely be monitored.

Item Type: Journal Article
Keywords: Reversible cerebral vasoconstriction syndrome, Call-Fleming syndrome, Benign angiopathy of the central nervous system, Thunderclap headache, Reversible vasospasm, Migrainous vasospasm, Drug-induced cerebral arteritis, Postpartum cerebral angiopathy, Central nervous system pseudovasculitis
Faculty: Faculty of Science & Engineering
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 23 Nov 2020 10:32
Last Modified: 09 Sep 2021 18:50

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