A common cause of sudden and thunderclap headaches: reversible cerebral vasoconstriction syndrome

Cheng, Yu‐Chen; Kuo, Kuei-Hong; Lai, Tzu-Hsien

doi:10.1186/1129-2377-15-13

Cited by 37 publications

(35 citation statements)

References 29 publications

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“…1) [3]. RCVS may have a broader spectrum than previously thought, ranging from pure cephalalgic forms with excruciating headaches without any stroke on brain imaging despite marked intracranial vasoconstriction [21], to forms with IS in the territory of RV and no headache. …”

Section: Discussionmentioning

confidence: 99%

Ischaemic Strokes with Reversible Vasoconstriction and without Thunderclap Headache: A Variant of the Reversible Cerebral Vasoconstriction Syndrome?

Wolff¹,

Armspach

Lauer

et al. 2014

Cerebrovasc Dis

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Background: Reversible vasoconstriction (RV) may cause ischaemic stroke (IS) in the absence of any other defined stroke aetiology. The three objectives of our study were to evaluate the frequency of RV in a prospective series of young IS patients, to describe the detailed clinical-radiological features in the patients with RV and IS, and to compare these characteristics with those of reversible cerebral vasoconstriction syndrome (RCVS). Methods: We identified between October 2005 and December 2010, 159 consecutive young patients (<45 years) hospitalized for an acute IS confirmed by cerebral magnetic resonance imaging. An extensive diagnostic work-up was performed including toxicological urinary screening for cannabis, cocaine and amphetamines, and the usual biological, cardiac and vascular investigations for an IS in the young. We specifically studied patients with IS and RV, which was defined as multifocal intracranial arterial stenoses confirmed by intracranial arterial imaging that resolved within 3-6 months. Results: Out of 159 patients with IS, 21 (13%, 12 males, 9 females; mean age 32 years) had multifocal cerebral arterial stenoses that were fully reversible at 3-6 months, and no other cause for stroke. IS were located on posterior territory in 71% of cases, and vasoconstriction predominated on posterior cerebral and superior cerebellar arteries. Precipitating factors of IS and RV were the use of cannabis resin (n = 14), nasal decongestants (n = 2) and triptan (n = 1). Most cases (74%) had unusual severe headache, but none had thunderclap headache. None of 21 cases had reversible posterior leukoencephalopathy, cortical subarachnoid or intracerebral haemorrhage. Conclusion: RV was the sole identified cause of IS in 13% of our cohort. These young patients with IS and RV may have a variant of RCVS, related to an increased susceptibility to vasoactive agents in some individuals. RV in our patients differs from the classical characteristics of RCVS by the absence of thunderclap headache, reversible brain oedema and subarachnoid or intracranial haemorrhage. Intracranial arteries should be looked for, by appropriate vascular imaging, in young patients with IS at the acute stage and during the follow-up period.

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Section: Discussionmentioning

confidence: 99%

Ischaemic Strokes with Reversible Vasoconstriction and without Thunderclap Headache: A Variant of the Reversible Cerebral Vasoconstriction Syndrome?

Wolff¹,

Armspach

Lauer

et al. 2014

Cerebrovasc Dis

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“…The diagnosis is easy when patients present with recurrent short‐lived TCH, brain imaging shows normal parenchyma, or PRES or convexity hemorrhage, and cerebral angiography demonstrates typical diffuse bilateral segmental beading …”

Section: Diagnosis Of Definite Rcvsmentioning

confidence: 99%

The Typical Thunderclap Headache of Reversible Cerebral Vasoconstriction Syndrome and its Various Triggers

2016

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During the last 10 years, reversible cerebral vasoconstriction syndrome (RCVS) has emerged as the most frequent cause of thunderclap headache (TCH) in patients without aneurysmal subarachnoid hemorrhage, and as the most frequent cause of recurrent TCHs. The typical TCHs of RCVS are multiple, recurring over a few days to weeks, excruciating, short-lived, and brought up by exertion, sexual activities, emotion, Valsalva maneuvers, or bathing, among other triggers. All these triggers induce sympathetic activation. In a minority of cases with RCVS, TCH heralds stroke and rarely death. Early diagnosis of RCVS in patients who present with isolated headache enables proper management and might reduce the risk of eventual stroke. This review describes the characteristics, triggers, diagnosis, and management of TCH in RCVS. One aim is to underline that the TCH pattern of RCVS is so typical that it enables, according to the 2013 revision of the International Classification of Headache Disorders, the diagnosis of "probable RCVS" in patients with such a headache pattern, normal cerebral angiography, and no other cause. Another objective is to discuss the role of physical and emotional stress in RCVS and in other related conditions involving similar triggers.

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“…In certain stroke subtypes, such as cerebral venous thrombosis, cervical and intracranial artery dissection, and reversible cerebral vasoconstriction syndrome, headache (and/or, in the case of dissection, facial pain) is the commonest presenting feature . Even excluding these stroke types, new headache associated with acute stroke is common (Table ) …”

Section: Defining Post‐stroke Headache – Current Framework and Challmentioning

confidence: 99%

A Narrative Review of Persistent Post‐Stroke Headache – A New Entry in the International Classification of Headache Disorders, 3rd Edition

et al. 2018

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A common cause of sudden and thunderclap headaches: reversible cerebral vasoconstriction syndrome

Cited by 37 publications

References 29 publications

Ischaemic Strokes with Reversible Vasoconstriction and without Thunderclap Headache: A Variant of the Reversible Cerebral Vasoconstriction Syndrome?

Ischaemic Strokes with Reversible Vasoconstriction and without Thunderclap Headache: A Variant of the Reversible Cerebral Vasoconstriction Syndrome?

The Typical Thunderclap Headache of Reversible Cerebral Vasoconstriction Syndrome and its Various Triggers

A Narrative Review of Persistent Post‐Stroke Headache – A New Entry in the International Classification of Headache Disorders, 3rd Edition

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