Abstract Details

Title Long-Term Stroke and Headache Outcomes in Reversible Cerebral Vasoconstriction Syndrome (RCVS)

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 236

Objective

Background BACKGROUND: RCVS is characterized by acute onset of severe headaches, with or without neurologic deficit with evidence of reversible cerebral vasoconstriction. Natural history and long term outcomes of RCVS have not been thoroughly investigated.

Design/Methods DESIGN/METHODS: Prospective cohort analysis of patients from the RCVS registry was conducted. Validated questionnaires were mailed to the patients. The forms included: Headache screening form, Headache Impact Test (HIT-6), Migraine Disability Assessment Test (MIDAS), Barthel Index (BI), EuroQoL (EQ-5D-5L) and Patient Health Questionnaire (PHQ-9).

Results RESULTS: From a total of 57 patients, 3 patients refused, 26 were lost to follow-up, 8 never replied, and 20 participated. Median follow-up time was 91.5 months (range 10-254). Of the 20 patients (90% female), 19 (95%) presented with thunderclap headache and had ischemic stroke (50%), subarachnoid (45%) or intracerebral (15%) hemorrhage. Eleven (55%) patients continued to have headache, but majority (91%) reported improvement in character with only 1 having worsening. Impact on life measured by HIT-6 showed that 2 (13%) patients had a severe impact (HIT score >=60). The mean MIDAS score was 10.67 and 2 (13%) patients had severe disabling headaches (MIDAS score >=21). Sixteen (94%) patients were independent by BI scores >=85. EQ-5D-5L measurements showed that 12 (71%), 14 (82%) and 12 (71%) patients had no problems with mobility, self-care and leisure respectively. PHQ-9 scores revealed that only 1 (6%) patient had severe depression (scores 20-27).

Conclusions CONCLUSIONS: These data on long-term outcomes in RCVS suggests that half of patients will continue to have headache, although decreased in severity and frequency. Although three-quarter of patients suffered an initial ischemic stroke or hemorrhage, almost all were independent with little disability. Pain and anxiety however decreased the QoL.

Authors/Disclosures
Seby John, MD (Cleveland Clinic Abu Dhabi) PRESENTER	Dr. John has nothing to disclose.
Kate Bushby, MD	Dr. Bushby has nothing to disclose.
	No disclosure on file
Ken Uchino, MD (Cleveland Clinic Foundation)	Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aboott Laboratories, Inc.. Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ACP JOURNAL CLUB. The institution of Dr. Uchino has received research support from NIH.
Rula Hajj-Ali, MD (Cleveland Clinic)	Rula Hajj-Ali, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Rula Hajj-Ali, MD has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zena. Rula Hajj-Ali, MD has received publishing royalties from a publication relating to health care.

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