Top

Neurocritical Care

Published in:

01-08-2007 | Original Paper

Severe reversible cerebral vasoconstriction syndrome mimicking aneurysmal rupture and vasospasm

Authors: Christopher Nickele, Kenji Muro, Christopher C. Getch, Matthew T. Walker, Richard A. Bernstein

Published in: Neurocritical Care | Issue 1/2007

Abstract

Introduction

Presenting symptoms of aneurysmal subarachnoid hemorrhage (SAH) and reversible cerebral vasoconstriction syndrome (RCVS) may overlap. Patients with RCVS often harbor unruptured aneurysms.

Summary of Case

We report a case of RCVS in a patient with an unruptured intracranial aneurysm. The development of diffuse vasoconstriction after aneursym clipping in the absence of any subarachnoid blood was initially confusing, until subtle vasoconstriction before clipping was seen retrospectively.

Results

We obtained perfusion and diffusion MRI studies on this patient, which shed light on the pathophysiology of RCVS.

Conclusion

It is important for physicians who care for patients with aneurysmal SAH to recognize RCVS, as the treatments for these two conditions are different.

Singhal AB, Bernstein RA. Postpartum angiopathy and other cerebral vasoconstriction syndromes. Neurocrit Care 2005;3(1):91–7.PubMedCrossRef

Bernstein RA. Reversible cerebral vasoconstriction syndromes. Curr Treat Options Cardiovasc Med 2006;8:229–34.PubMedCrossRef

Call GK, Fleming MC, Sealfon S, Levine H, Kistler JP, Fisher CM. Reversible cerebral segmental vasoconstriction. Stroke 1988;19(9):1159–70.PubMed

Ringer AJ, Qureshi AI, Kim SH, Fessler RD, Guterman LR, Hopkins LN. Angioplasty for cerebral vasospasm from eclampsia. Surg Neurol 2001;56(6):373–8, (discussion 378–9).PubMedCrossRef

Singhal AB, Caviness VS, Begleiter AF, Mark EJ, Rordorf G, Koroshetz WJ. Cerebral vasoconstriction and stroke after use of serotonergic drugs.[see comment]. Neurology 2002;58(1):130–3.PubMed

Singhal AB. Postpartum angiopathy with reversible posterior leukoencephalopathy. Arch Neurol 2004;61(3):411–6.PubMedCrossRef

Day JW, Raskin NH. Thunderclap headache: symptom of unruptured cerebral aneurysm. Lancet 1986;2(8518):1247–8.PubMed

Singhal AB. Thunderclap headache, reversible cerebral arterial vasoconstriction, and unruptured aneurysms.[comment]. J Neurol Neurosurg Psychiatry 2002;73(1):96, (author reply 96–7).PubMedCrossRef

Calabrese LH. Vasculitis of the central nervous system. Rheum Dis Clin North Am 1995;21(4):1059–76.PubMed

10.

Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998;55(11):1475–82.PubMedCrossRef

Title: Severe reversible cerebral vasoconstriction syndrome mimicking aneurysmal rupture and vasospasm
Authors: Christopher Nickele
Kenji Muro
Christopher C. Getch
Matthew T. Walker
Richard A. Bernstein
Publication date: 01-08-2007
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 1/2007
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-007-0001-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Severe reversible cerebral vasoconstriction syndrome mimicking aneurysmal rupture and vasospasm

Abstract

Introduction

Summary of Case

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Summary of Case

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2007

New Approaches to Physiological Informatics in Neurocritical Care

Child health-related quality of life following neurocritical care for traumatic brain injury: an analysis of preference-weighted outcomes

Cerebral infarction associated with acute subarachnoid hemorrhage

Cerebral vasospasm in shunt infection

Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage

Splanchnic ischemia and gut permeability after acute brain injury secondary to intracranial hemorrhage