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Li S, Yang Y, Zuo J, Du N, Kou G. Reversible cerebral vasoconstriction syndrome following intracranial hypotension in a postpartum patient: a case report and literature review. Front Neurol 2023; 14:1281074. [PMID: 37900590 PMCID: PMC10602719 DOI: 10.3389/fneur.2023.1281074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Reversible cerebral vasoconstriction syndrome (RCVS) is a potentially life-threatening neurological disorder, rarely linked to intracranial hypotension. The presentation showed a patient with intracranial hypotension after peridural anesthesia who experienced RCVS during the early postpartum period, suggesting a potential involvement of intracranial hypotension in RCVS occurrence. Case report A young female of 29 years of age initially developed an orthostatic headache after undergoing a painless delivery with lumbar epidural anesthesia. Intracranial hypotension was considered the underlying cause. Her headache was partially resolved after intravenous fluid therapy and strict bed rest. After 2 days, the patient had a new onset thunderclap headache with generalized seizures, cortical blindness, and elevated blood pressure. An MRI scan revealed high signal intensity within the temporal, parietal, and occipital lobes, left caudate nucleus, and right cerebellum on T2-FLAIR imaging with vasogenic edema. MR angiography indicated multifocal, segmental, diffuse narrowing affecting the cerebral arteries that are large and medium. An RCVS2 score was six, and the patient was diagnosed with RCVS. She was managed conservatively, quickly improving her symptoms. After 10 days, a follow-up MRI indicated a significant reduction in the abnormal signal, and a substantial resolution of the constriction of the cerebral artery constriction was confirmed by MR angiography. Conclusion Intracranial hypotension could potentially lead to RCVS in postpartum patients, and it may be triggered by cerebral vasospasm secondary to intracranial hypotension.
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Affiliation(s)
- Shuhua Li
- Department of Infectious Diseases, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Yi Yang
- Department of Neurology, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiacai Zuo
- Department of Neurology, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Ningli Du
- Department of Infectious Diseases, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Guoxian Kou
- Department of Infectious Diseases, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
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Lee DE, Krishnan A, Collins R. Reversible cerebral vasoconstriction syndrome in the postpartum period: A case report and review of the literature. Int J Gynaecol Obstet 2023; 162:823-828. [PMID: 36965125 DOI: 10.1002/ijgo.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/24/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare phenomenon that can present in the postpartum period. We show the experience of a 35-year-old patient who presented with headache after an uncomplicated pregnancy and vaginal delivery. She was initially diagnosed with pre-eclampsia, and subsequently with RCVS following discovery of multifocal vascular narrowing on magnetic resonance arteriography (MRA). Verapamil was initiated, and at 1 month there was improvement intracranially, but cervical vertebral arterial narrowing, likely dissection, was discovered. Verapamil was continued and aspirin was initiated. Follow-up imaging 5 months postpartum demonstrated near-complete resolution of previously noted abnormalities, which remained stable at reimaging at 10 months postpartum. In conclusion, the symptoms of RCVS can mimic or coexist with pre-eclampsia. Early intracranial imaging such as MRA can permit timely diagnosis and facilitate appropriate management and follow-up.
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Affiliation(s)
- David E Lee
- Department of Obstetrics & Gynecology, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Anant Krishnan
- Department of Diagnostic Radiology and Molecular Imaging, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Riley Collins
- Department of Obstetrics & Gynecology, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
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3
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Reversible cerebral vasoconstriction syndrome after intravenous iron substitution: a case report. J Neurol 2022; 269:3918-3922. [PMID: 35152334 PMCID: PMC9217862 DOI: 10.1007/s00415-022-11011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
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4
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Pensato U, Matteo E, Cevoli S. The unforgivable curse of Harry Potter's thunderclap headaches. Headache 2021; 61:1287-1290. [PMID: 34510446 PMCID: PMC9293176 DOI: 10.1111/head.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Umberto Pensato
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Eleonora Matteo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- UOC Clinica Neurologica NEUROMET, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italia
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Abstract
New onset or exacerbation of preexisting neurologic symptoms during pregnancy often necessitates brain or spinal cord imaging. Magnetic resonance techniques are preferred imaging modalities during pregnancy and the postpartum period. Ionizing radiation with computed tomography and intravenous contrast material with magnetic resonance or computed tomography should be avoided during pregnancy. New onset of headaches in the last trimester or in the postpartum period may indicate cerebrovascular disease or a mass lesion, for which brain imaging is necessary. The continuum of cerebrovascular complications of pregnancy and enlarging lesions may produce neurologic symptoms later in pregnancy and after delivery, necessitating imaging.
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Affiliation(s)
- Dara G Jamieson
- Department of Neurology, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA.
| | - Jennifer W McVige
- Dent Neurologic Institute, 3980 Sheridan Drive, Amherst, NY 14226, USA
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6
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Park SY, Lee JH, Shin IJ, Nogueira RG, Lee JS. Nimodipine-refractory reversible cerebral vasoconstriction syndrome treated effectively with verapamil. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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7
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Pensato U, Cevoli S, Cirillo L. Vessel Wall Imaging in Thunderclap Headache: A Reversible Cerebral Vasoconstriction Syndrome (RCVS) Case. Headache 2020; 60:2633-2635. [PMID: 33112429 DOI: 10.1111/head.13992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Umberto Pensato
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luigi Cirillo
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
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9
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Reversible Cerebral Vasoconstriction Syndrome: an Update of Recent Research. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00137-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Hong JH. Cerebrovascular complications during pregnancy and postpartum. JOURNAL OF NEUROCRITICAL CARE 2019. [DOI: 10.18700/jnc.190087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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11
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Seizures in patients with a phaeochromocytoma/paraganglioma (PPGL): A review of clinical cases and postulated pathological mechanisms. Rev Neurol (Paris) 2019; 175:495-505. [PMID: 31133278 DOI: 10.1016/j.neurol.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/30/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022]
Abstract
The purpose of this work was to expound on the postulated pathological mechanisms through which pheochromocytoma/paraganglioma (PPGL) can cause seizures by conducting a comprehensive review of ten cases and several pathogenic mechanisms. The goal was to enhance awareness amongst doctors and researchers about patients with PPGL presenting with seizures. This would help decrease the risk of misdiagnosis and mismanagement in future clinics. Additionally, this review was written with the purpose to attract more attention to etiological explorations, particularly concerning rare causes of seizures, which is consistent with the idea that League Against Epilepsy (ILAE) has emphasized in the new version of the ILAE position paper published in 2017. It is of great importance to keep in mind the fact that seizures can constitute an atypical presentation of PPGL and to establish early diagnosis and accurate cure for these patients, especially in the presence of paroxysmal hypertension or other suggestive symptoms of PPGL.
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Choi EH, Yu I, Park JH, Yoon CW, Bang OY. Reversible cerebral vasoconstriction syndrome without typical thunderclap headache: highresolution magnetic resonance imaging features. PRECISION AND FUTURE MEDICINE 2018. [DOI: 10.23838/pfm.2018.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Kasuya C, Suzuki M, Koda Y, Sato H, Kashima K, Honda K, Kazama Y, Akiyama K, Seki Y, Yoneoka Y. A headache-free reversible cerebral vasoconstriction syndrome (RCVS) with symptomatic brain stem ischemia at late pregnancy as a rare manifestation of RCVS resolved with termination of pregnancy by semi-urgent cesarean section. Oxf Med Case Reports 2018; 2018:omy101. [PMID: 30487987 PMCID: PMC6247141 DOI: 10.1093/omcr/omy101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 11/13/2022] Open
Abstract
A 32-year-old pregnant woman in her 39th week of pregnancy presented at the emergency room complaining of sudden-onset dizziness with gaze disturbance and was admitted to our hospital. Her past medical history included hypertension, diabetes mellitus and infarction in the right medulla oblongata 18 months prior to this event. Magnetic resonance (MR) angiography showed multiple irregular stenosis of the intracranial arterial system. Although MR images revealed no fresh ischemic or hemorrhagic lesions, she was diagnosed with reversible cerebral vasoconstriction syndrome (RVCS) associated with pregnancy. Cesarean section immediately resolved the headache-free ischemic RCVS. The postpartum course of the patient was uneventful as well as that of her baby. Follow-up MR angiography showed improvement of intracranial vasoconstriction and follow-up MR imaging showed improvement of a left medial pontine ischemic lesion on diffusion-weighted image. This report describes a rare manifestation of pregnancy-related RCVS.
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Affiliation(s)
- Chisato Kasuya
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Mina Suzuki
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Yukako Koda
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Hitomi Sato
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Katsunori Kashima
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Keisuke Honda
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Yoshiki Kazama
- Department of Obstetrics and Gynecology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Katsuhiko Akiyama
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Yasuhiro Seki
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
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Al-Mufti F, Dodson V, Wajswol E, El-Ghanem M, Alchaki A, Nuoman R, Thabet A, Sutherland A, Roychowdhury S, Hidalgo A, Gupta G. Chemical angioplasty for medically refractory reversible cerebral vasoconstriction syndrome. Br J Neurosurg 2018; 32:431-435. [DOI: 10.1080/02688697.2018.1479512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Fawaz Al-Mufti
- Rutgers University – Robert Wood Johnson Medical School, Department of Neurology, New Brunswick NJ, USA
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Vincent Dodson
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Ethan Wajswol
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Mohammad El-Ghanem
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Abdulrahman Alchaki
- Rutgers University – New Jersey Medical School, Department of Neurology, Newark, NJ, USA
| | - Rolla Nuoman
- Rutgers University – New Jersey Medical School, Department of Neurology, Newark, NJ, USA
| | - Ahmad Thabet
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Anne Sutherland
- Rutgers University – New Jersey Medical School, Department of Medicine, Newark, NJ, USA
| | - Sudipta Roychowdhury
- Rutgers University – Robert Wood Johnson Medical School, Department of Radiology, New Brunswick NJ, USA
| | - Andrea Hidalgo
- Rutgers University – New Jersey Medical School, Department of Neurology, Newark, NJ, USA
| | - Gaurav Gupta
- Rutgers University – Robert Wood Johnson Medical School, Department of Neurosurgery, New Brunswick NJ, USA
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16
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Cauldwell M, Rudd A, Nelson-Piercy C. Management of stroke and pregnancy. Eur Stroke J 2018; 3:227-236. [PMID: 31008353 PMCID: PMC6453206 DOI: 10.1177/2396987318769547] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/10/2018] [Indexed: 11/17/2022] Open
Abstract
Stroke continues to be one of the main causes of death in the developed countries and the incidence in pregnancy appears to be increasing. Pregnancy-related stroke has a relatively high mortality rate of 10% and so clinicians need to be mindful of appropriate investigations and referral of a pregnant woman with suspected stroke, so they can receive timely treatment. In this review we address the risk factors associated with stroke, diagnosis and appropriate management of the different stroke types. We also discuss implications for care around pregnancy and delivery as well as reviewing how a pregnancy with previous stroke should be managed.
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van Alebeek ME, Arntz RM, Ekker MS, Synhaeve NE, Maaijwee NAMM, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LCA, de Leeuw FE. Risk factors and mechanisms of stroke in young adults: The FUTURE study. J Cereb Blood Flow Metab 2018; 38:1631-1641. [PMID: 28534705 PMCID: PMC6120122 DOI: 10.1177/0271678x17707138] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/17/2017] [Indexed: 11/16/2022]
Abstract
Incidence of ischemic stroke and transient ischemic attack in young adults is rising. However, etiology remains unknown in 30-40% of these patients when current classification systems designed for the elderly are used. Our aim was to identify risk factors according to a pediatric approach, which might lead to both better identification of risk factors and provide a stepping stone for the understanding of disease mechanism, particularly in patients currently classified as "unknown etiology". Risk factors of 656 young stroke patients (aged 18-50) of the FUTURE study were categorized according to the "International Pediatric Stroke Study" (IPSS), with stratification on gender, age and stroke of "unknown etiology". Categorization of risk factors into ≥1 IPSS category was possible in 94% of young stroke patients. Chronic systemic conditions were more present in patients aged <35 compared to patients ≥35 (32.6% vs. 15.6%, p < 0.05). Among 226 patients classified as "stroke of unknown etiology" using TOAST, we found risk factors in 199 patients (88%) with the IPSS approach. We identified multiple risk factors linked to other mechanisms of stroke in the young than in the elderly . This can be a valuable starting point to develop an etiologic classification system specifically designed for young stroke patients.
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Affiliation(s)
- Mayte E van Alebeek
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Merel S Ekker
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, Elisabeth
Tweesteden Hospital, PO Box 90151, 5000, LC Tilburg, the Netherlands
| | - Noortje AMM Maaijwee
- Center for Neurology and
Neurorehabilitation, Luzern State Hospital, Luzern, Switzerland
| | - Hennie Schoonderwaldt
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
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Yamada K, Iso H, Cui R, Tamakoshi A. Recurrent Pregnancy Loss and Cardiovascular Disease Mortality in Japanese Women: A Population-Based, Prospective Cohort Study. J Stroke Cerebrovasc Dis 2017; 26:1047-1054. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 12/16/2016] [Accepted: 12/23/2016] [Indexed: 01/19/2023] Open
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Cappelen-Smith C, Calic Z, Cordato D. Reversible Cerebral Vasoconstriction Syndrome: Recognition and Treatment. Curr Treat Options Neurol 2017; 19:21. [DOI: 10.1007/s11940-017-0460-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Pregnant women are most likely to have primary headaches, such as migraine and tension-type headaches, which can be diagnosed and treated without brain imaging. Primary headaches may even start de novo during pregnancy, especially in the first few months. However, when the headache occurs late in pregnancy or in the peripartum period, secondary causes of headaches need to be considered and evaluated by brain and/or vascular imaging, generally using magnetic resonance techniques. There is considerable overlap between the cerebrovascular complications of pregnancy, including preeclampsia/eclampsia, posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), and both hemorrhagic and ischemic strokes; although, their imaging may be distinctive. Imaging is necessary to distinguish between arterial and venous pathology causing headache in the peripartum patient, as there can be similar presenting symptoms. Mass lesions, both neoplastic and inflammatory, can enlarge and produce headaches and neurological symptoms late in pregnancy.
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Affiliation(s)
- Maryna Skliut
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 10 Union Square E, Suite 5 D, New York, NY, 10003, USA
| | - Dara G Jamieson
- Weill Cornell Medicine, New York Presbyterian Hospital, 428 East 72nd Street, Suite 400, New York, NY, 10021, USA.
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Ollivier M, Bertrand A, Clarençon F, Gerber S, Deltour S, Domont F, Trunet S, Dormont D, Leclercq D. Neuroimaging features in posterior reversible encephalopathy syndrome: A pictorial review. J Neurol Sci 2017; 373:188-200. [DOI: 10.1016/j.jns.2016.12.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
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Baharith H, Zarrin A. Khat - a new precipitating factor for reversible cerebral vasoconstriction syndrome: a case report. J Med Case Rep 2016; 10:351. [PMID: 27978853 PMCID: PMC5160011 DOI: 10.1186/s13256-016-1155-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 11/23/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Postpartum reversible cerebral vasoconstriction syndrome is one of the rare reversible cerebral vasoconstriction syndromes. The clinical presentation is usually characterized by recurrent headache, focal neurological deficit, and reversible cerebral vasoconstriction seen on cerebral angiography. CASE PRESENTATION We report a case of a 35-year-old Yemeni woman who presented with headache and focal neurological deficits that occurred 10 days after delivery, with segmental narrowing of cerebral arteries on angiography. She had significant clinical and radiological improvement on follow-up. CONCLUSIONS The presentation of our patient's reversible cerebral vasoconstriction syndrome is unusual as she has two possible precipitating factors. In addition to being in the postpartum state, she also has a long history of chewing khat, a vasoactive substance commonly used by immigrants from Yemen. We hope that this case report will increase awareness among physicians about the use of this plant by immigrants from the horn of Africa and Yemen.
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Affiliation(s)
- Harith Baharith
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, USA.
| | - Amy Zarrin
- Department of Medicine, Center for Neuroscience, New York Methodist Hospital, Brooklyn, NY, USA
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Edlow AG, Edlow BL, Edlow JA. Diagnosis of Acute Neurologic Emergencies in Pregnant and Postpartum Women. Emerg Med Clin North Am 2016; 34:943-965. [PMID: 27741996 DOI: 10.1016/j.emc.2016.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute neurologic symptoms in pregnant and postpartum women may be caused by exacerbation of a preexisting neurologic condition, the initial presentation of a non-pregnancy-related problem, or a new neurologic problem. Pregnant and postpartum patients with headache and neurologic symptoms are often diagnosed with preeclampsia or eclampsia; however, other etiologies must also be considered. A team approach with close communication between emergency physicians, neurologists, maternal-fetal medicine specialists, and radiologists is the key to obtaining best outcomes. This article reviews the clinical features and differential diagnosis of acute serious neurologic conditions in pregnancy and the puerperium, focusing on diagnosis.
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Affiliation(s)
- Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mother Infant Research Institute, Tufts Medical Center, 800 Washington Street, Box 394, Boston, MA 02111, USA
| | - Brian L Edlow
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA 02114, USA
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Place, West Clinical Center, 2nd Floor, Boston, MA 02215, USA.
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Wojak JC, Abruzzo TA, Bello JA, Blackham KA, Hirsch JA, Jayaraman MV, Dariushnia SR, Meyers PM, Midia M, Russell EJ, Walker TG, Nikolic B. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2015; 26:1596-608. [DOI: 10.1016/j.jvir.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/19/2022] Open
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Farmakidis C, Inan S, Milstein M, Herskovitz S. Headache and Pain in Guillain-Barré Syndrome. Curr Pain Headache Rep 2015; 19:40. [DOI: 10.1007/s11916-015-0508-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Calic Z, Cappelen-Smith C, Zagami AS. Reversible cerebral vasoconstriction syndrome. Intern Med J 2015; 45:599-608. [DOI: 10.1111/imj.12669] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 12/06/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Z. Calic
- Institute of Neurological Sciences; Prince of Wales Hospital; Sydney Australia
- Prince of Wales Clinical School; University of New South Wales; Sydney Australia
| | - C. Cappelen-Smith
- Department of Neurology and Neurophysiology; Liverpool Hospital; Sydney New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney Australia
| | - A. S. Zagami
- Institute of Neurological Sciences; Prince of Wales Hospital; Sydney Australia
- Prince of Wales Clinical School; University of New South Wales; Sydney Australia
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Skeik N, Porten BR, Kadkhodayan Y, McDonald W, Lahham F. Postpartum reversible cerebral vasoconstriction syndrome: Review and analysis of the current data. Vasc Med 2015; 20:256-65. [DOI: 10.1177/1358863x14567976] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postpartum reversible cerebral vasoconstriction syndrome (PPRCVS) is a rare but serious cause of headache that occurs in the early postpartum period. The rarity of this disorder has limited the current literature to single case reports and small, observational case series. The lack of familiarity with PPRCVS may contribute to mismanagement of these unique patients and lead to poor outcomes. To address current gaps in the understanding of PPRCVS, this review and data analysis characterizes the demographics, presentation, clinical course, management and prognosis of PPRCVS and provides a general review of the epidemiology, pathophysiology and diagnosis to assist clinicians who may care for patients with this rare disorder.
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Affiliation(s)
- Nedaa Skeik
- Vascular Medicine, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Yasha Kadkhodayan
- Department of Pathology, Interventional Neuroradiology, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Firas Lahham
- Internal Medicine, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Abstract
Stroke is the leading cause of acquired disability and the third leading cause of death in women worldwide. Sex differences in risk factors, treatment response and quality of life after stroke complicate stroke management in women. Women have an increased lifetime incidence of stroke compared to men, largely due to a sharp increase in stroke risk in older postmenopausal women. Women also have an increased lifetime prevalence of stroke risk factors, including hypertension and atrial fibrillation in postmenopausal women, as well as abdominal obesity and metabolic syndrome in middle-aged women. Controversy continues over the risks of oral contraceptives, hormone therapy and surgical intervention for carotid stenosis in women. Pregnancy and the postpartum period represent a time of increased risk, presenting challenges to stroke management. Recognition of these issues is critical to improving acute care and functional recovery after stroke in women.
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Affiliation(s)
- Matthew D Howe
- Department of Neuroscience, The University of Connecticut Health Center, Farmington, CT 06030, USA
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