Reversible cerebral vasoconstriction syndrome (RCVS): an interesting case report

Development of therapeutic supplement using roasted-cashew-nut to protect cerebral vasoconstriction injury triggered by mixture of petroleum hydrocarbons in the hypothalamus and hippocampus of rat model

Petroleum-related activities have been a health global risk concern, particularly in the limbic disorders. The study aims to investigate the neuroprotection of roasted cashew nuts (RCN) on brain vasoconstriction injury induced by a mixture of petroleum hydrocarbons (MFPP). Seventy Male Wistar rats ranging 160 ± 10 g were randomized into seven groups. Group I was given distilled water. Group II was exposed to 0.2 ml MFPP. Group III, IV and V were exposed to 0.2 ml MFPP followed by treatment with 50 mg/kg atenolol, 10 % RCN and 20 % RCN, respectively. Group VI and VII were treated with 10 % RCN and 20 % RCN, respectively. The regimen period was 28 days. Cell pathological evaluation was done using hematoxylin and eosin staining and visualized under the microscope. Biochemical and molecular markers of brain vasoconstriction injury (BVI) were evaluated using spectrophotometer and RT-PCR analyzer, respectively. Student-T-test and one-way analysis of variance (ANOVA) were used to analyze the results. Sub-chronic exposure to MFPP induced BVI as evident in neuroinflammation and derangements in the histology of the hippocampus and hypothalamus coupled with momentous alterations in the neurons. Post treatment with RCN supplement remarkably modulated the effects by depleting the inflammatory mediators including HIF-1, p53 and MCP-1. Also, adenosinergic, purigenic and cholinergic of the hypothalamus and hippocampus were normalized by the supplement. It is pertinent to conclude that treatment with RCN inhibited BVI in rats via the NO-cAMP-PKA signaling pathway by reversing neuroinflammation, normalizing the purinergic and cholinergic neurotransmission in the hypothalamus and hippocampus, and stabilizing NO level coupled with brain histology improvement.

Snakebite-induced reversible cerebral vasoconstriction syndrome: Report of three cases

Envenomings from Russell's viper typically result in local tissue damage and bleeding complications, but the bites from common krait and cobra primarily cause neurotoxic effects. While most symptoms can be treated with appropriate antivenom, additional support is necessary for several snakebite victims to tackle a broad range of unusual complications that they develop following bites. Reversible vasoconstriction syndrome (RCVS), characterised by the constriction of cerebral arteries, is a rare but serious issue, presenting with severe headaches and, in extreme cases, haemorrhagic/ischaemic stroke. This report presents three cases of RCVS in snakebite victims following Russell's viper, krait and cobra bites. The patients were admitted to the hospital with neurological and/or haematological complications, and they were treated with polyvalent antivenom. After two days of antivenom treatment, all the patients developed intense headaches that lasted for several hours and failed to respond to commonly used analgesics. While the physical, laboratory and computed tomography examinations were normal, the RCVS was diagnosed with multimodal magnetic resonance angiography. All patients were successfully treated with oral nimodipine, and during their follow-ups, physical and laboratory examinations were unremarkable, and the magnetic resonance imaging confirmed the reversal of RCVS. To achieve positive outcomes in patients, clinicians must swiftly identify such rare complications and make accurate diagnoses to provide prompt treatments. Overall, this report presents an unusual complication of RCVS in snakebite patients and appropriate diagnosis and treatment approaches to tackle this condition.

Association between impaired dynamic cerebral autoregulation and BBB disruption in reversible cerebral vasoconstriction syndrome

BACKGROUND

Half of the sufferers of reversible cerebral vasoconstriction syndrome (RCVS) exhibit imaging-proven blood-brain barrier disruption. The pathogenesis of blood-brain barrier disruption in RCVS remains unclear and mechanism-specific intervention is lacking. We speculated that cerebrovascular dysregulation might be associated with blood-brain barrier disruption in RCVS. Hence, we aimed to evaluate whether the dynamic cerebral autoregulation is altered in patients with RCVS and could be associated with blood-brain barrier disruption.

METHODS

A cross-sectional study was conducted from 2019 to 2021 at headache clinics of a national tertiary medical center. Dynamic cerebral autoregulation was evaluated in all participants. The capacity of the dynamic cerebral autoregulation to damp the systemic hemodynamic changes, i.e., phase shift and gain between the cerebral blood flow and blood pressure waveforms in the very-low- and low-frequency bands were calculated by transfer function analysis. The mean flow correlation index was also calculated. Patients with RCVS received 3-dimensional isotropic contrast-enhanced T2 fluid-attenuated inversion recovery imaging to visualize blood-brain barrier disruption.

RESULTS

Forty-five patients with RCVS (41.9 ± 9.8 years old, 29 females) and 45 matched healthy controls (41.4 ± 12.5 years old, 29 females) completed the study. Nineteen of the patients had blood-brain barrier disruption. Compared to healthy controls, patients with RCVS had poorer dynamic cerebral autoregulation, indicated by higher gain in very-low-frequency band (left: 1.6 ± 0.7, p = 0.001; right: 1.5 ± 0.7, p = 0.003; healthy controls: 1.1 ± 0.4) and higher mean flow correlation index (left: 0.39 ± 0.20, p = 0.040; right: 0.40 ± 0.18, p = 0.017; healthy controls: 0.31 ± 0.17). Moreover, patients with RCVS with blood-brain barrier disruption had worse dynamic cerebral autoregulation, as compared to those without blood-brain barrier disruption, by having less phase shift in very-low- and low-frequency bands, and higher mean flow correlation index.

CONCLUSIONS

Dysfunctional dynamic cerebral autoregulation was observed in patients with RCVS, particularly in those with blood-brain barrier disruption. These findings suggest that impaired cerebral autoregulation plays a pivotal role in RCVS pathophysiology and may be relevant to complications associated with blood-brain barrier disruption by impaired capacity of maintaining stable cerebral blood flow under fluctuating blood pressure.

Reversible cerebral vasoconstriction syndrome: literature review

Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a neurovascular condition characterized by a severe sudden-onset headache that may be associated with focal neurological deficits. On imaging, the suggestive finding corresponds to multifocal vasoconstriction of the cerebral arteries, with a spontaneous resolution of approximately 12 weeks. The identification of precipitating factors and diagnosis must be carried out early, so that adequate management is established and the patient has a good prognosis, given the risk of secondary complications and residual neurological deficits. This study consists of a literature review based on the analysis of articles published between 2017 and 2022 in PubMed, SciELO, and ScienceDirect on RCVS, intending to understand the clinical and radiological characteristics, diagnosis, treatment, and prognosis of patients with RCVS. The pathophysiology, drug management, and prognosis still lack solid evidence; therefore, further studies on RCVS are needed to expand medical knowledge and avoid underdiagnosis and inadequate treatment of this important condition.

RCVS: by clinicians for clinicians-a narrative review

BACKGROUND/OBJECTIVE

Reversible cerebral vasoconstriction syndrome may be underdiagnosed. It can be accompanied by various complications, mainly intracerebral hemorrhage and ischemic stroke. The clinical presentation of this condition varies according to its localization. The aims of this review are to raise awareness of the disease, especially in the presence of corresponding risk factors; to connect its precipitating factors, pathophysiology, and complications; and to compare various differential diagnoses of vasoconstriction.

METHODS

A review of the literature in PubMed/MEDLINE and Google Scholar was conducted from May 1997 until May 2022.

RESULTS

Reversible cerebral vasoconstriction syndrome, which is a clinical-radiological syndrome, is mainly characterized by the occurrence of thunderclap headache and widespread vasoconstriction. The most common precipitating factors are the use of vasoactive substances and postpartum status. The pathophysiology is currently assumed to include two mechanisms: sympathetic overactivity and endothelial dysfunction. From these mechanisms, it is possible to derive potential complications as well as the most important differential diagnoses: posterior reversible encephalopathy syndrome, convexity subarachnoid hemorrhage, ischemic and hemorrhagic stroke, and primary angiitis of the central nervous system.

CONCLUSION

In general, the outcome of reversible cerebral vasoconstriction syndrome is very good. Vasospasm as well as thunderclap headache attacks can be fully reversible, and > 90% of patients are functionally independent at discharge.

Serial Magnetic Resonance Imaging and Magnetic Resonance Angiographic Findings of Reversible Cerebral Vasoconstriction Syndrome Associated with Postpartum

We report 2 cases of reversible cerebral vasoconstriction syndrome (RCVS) associated with postpartum. In case 1, a 26-year-old woman developed sudden-onset headache, nausea, and vomiting 1 h after an uncomplicated vaginal delivery. In case 2, a 27-year-old woman developed generalized seizures 9 days after an uncomplicated vaginal delivery. In both cases, initial angiographic studies showed no significant vasoconstriction; however, repeat studies revealed reversible vasoconstriction. Serial magnetic resonance imaging (MRI) revealed transient brain lesions during 6 months. RCVS remains poorly characterized, misdiagnosed, and under-recognized. Serial MRI and magnetic resonance angiographic findings may contribute to diagnosis of RCVS.