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Abstract Details

High Frequency of Incidental Angiographic Abnormalities in RCVS: Implications For Pathophysiology?
Cerebrovascular Disease and Interventional Neurology
P03 - (-)
164
BACKGROUND: RCVS is characterized by recurrent thunderclap headaches and reversible cerebral vasoconstriction. Its pathophysiology is unknown; no structural abnormality is identified on histopathology or electron microscopy. In addition to multifocal vasoconstriction, incidental angiographic abnormalities such as dissection and unruptured aneurysms have been documented in RCVS.
DESIGN/METHODS: We compared incidental angiographic findings on transfemoral, CT, or MR-angiography, in 124 consecutive RCVS vs. 114 non-RCVS patients. The latter group comprised n=33 with PACNS and n=81 consecutive 'Controls' who underwent CT-angiography for chronic headache (n=26), seizures (n=15), isolated sensory symptoms (n=16), or dizziness (n=24). Patients undergoing follow-up scans for known vascular lesions were excluded.
RESULTS: The number of patients with incidental abnormalities tended to differ between the 3 groups (Chi-Square p=0.09). There were significantly more patients with incidental findings in the RCVS group versus the non-RCVS group (27% vs. 16%, p=0.02). The RCVS group tended to have more patients with incidental findings as compared to Controls (p=0.06), but not PACNS (p=0.16). The RCVS group had 9 patients with cervical artery dissection, as compared to 1 patient in the non-RCVS group who had PACNS with 3 dissections. There was no significant difference in the number of patients with unruptured aneurysms. Five RCVS patients had cavernomas. Two RCVS patients had persistent extracranial findings suggestive of fibromuscular dysplasia, despite reversal of intracerebral vasoconstriction. There was no significant difference between Controls and PACNS in the number of patients with incidental abnormalities (p=1.0).
CONCLUSIONS: RCVS is associated with a high frequency of angiographic abnormalities such as cerebral artery dissection. Further studies are warranted to determine whether these reflect a subtle underlying structural abnormality that lowers the threshold for RCVS.
Authors/Disclosures

PRESENTER 		No disclosure on file
Aneesh B. Singhal, MD, FAAN (Massachusetts General Hospital) An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (好色先生) with Biogen.
Krzysztof W. Selmaj (University of Warmia and Mazury) Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.