Abstract Details

Title Clinical Worsening in Reversible Cerebral Vasoconstriction Syndrome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 217

Objective

Background BACKGROUND: Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a neurologic syndrome, characterized by recurrent thunderclap headache (TCH), radiographic evidence of vasoconstriction with subsequent resolution, and normal/near normal CSF profile. The clinical course of RCVS traditionally considered monophasic and benign.

Design/Methods DESIGN/METHODS: We performed a retrospective chart review at two institutions of a total of 57 patients who met definitive or probable criteria for RCVS. We defined clinical worsening as permanent or transient neurologic deficits as permanent or transient neurologic deficits or onset of seizures. Patients without evidence of angiographic vasoconstriction were excluded. We performed a univariate analysis using Chi-Squared or two sided Fishers Exact test.

Results RESULTS: We identified 57 patients (mean age, 44.6 years; range, 15-75). 21/57 (38%) patients clinically worsened after the diagnosis of RCVS with average time from diagnosis to worsening of 4.2 days (range several hours - 11 days later); 8 of the 21 patients who worsened had permanent deficits including 4 patients who died. 41 patients had a conventional cerebral angiogram, and of these 6 (14.6%) clinically worsened within 24 hours after catheter cerebral angiogram. Of the 6 patients who worsened, neurologic deficits were permanent in 4 and transient in 6. 16 patients had noninvasive angiograms rather than conventional. Of these patients 4 patients (25%) worsened after diagnosis (2 died and 1 was left in a minimally conscious state). We did not find an association between age (p=0.524), gender (p=0.243), history of smoking (p= 0.7180), history of migraine (p= 0.541), peripartum state (p=0.404), or acute hypertension (p=0.491) with clinical worsening after diagnosis.

Conclusions CONCLUSIONS: RCVS does not always follow a monophasic or benign course. A considerable proportion of patients in our series clinically worsened following the diagnosis of RCVS.

Authors/Disclosures
Brian S. Katz, MD (OhioHealth Neurological Physicians) PRESENTER	No disclosure on file
Douglas L. Arnold, MD, FAAN (Montreal Neurological Institute, McGill Univ)	Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BMS. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Frequency Therapeutics. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Xfacto communications. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Find therapeutics. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GSK. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Idorsia. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kiniksa. Dr. Arnold has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Clario.
Jennifer E. Fugate, DO (Mayo Clinic)	Dr. Fugate has nothing to disclose.
	No disclosure on file
Sebastian F. Ameriso, MD	Dr. Ameriso has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PHRI. Dr. Ameriso has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Bayer, Boehringer, Abbott, AstraZeneca.
Alejandro A. Rabinstein, MD, FAAN (Mayo Clinic)	Dr. Rabinstein has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Shionogi . Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chiesi. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceribell. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical care/NCS-Springer. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters/UptoDate. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO/DynaMed. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care.

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