RCVS and TGA: a common pathophysiology?

Kamm, Katharina; Schöberl, Florian; Grabova, Denis; Straube, Andreas; Zwergal, Andreas

doi:10.1007/s00415-019-09495-7

Cited by 9 publications

(4 citation statements)

References 16 publications

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“…RCVS and TGA are two acute and reversible intra-cerebral conditions whose coexistence has, to our knowledge, only been reported in a total of six cases worldwide (Table 1). 1,3,6,7 We report the seventh case, linking RCVS to TGA and propose a common pathophysiologic link.…”

Section: Discussionmentioning

confidence: 89%

“…Suggested mechanisms include increased energy requirements and metabolic disturbances from emotional arousal, Valsalva induced hippocampal venous congestion, arterial watershed compromise in hippocampal Sommer sectors 1,9 . The exact mechanism responsible for the underlying relationship between TGA and RCVS remains unknown; however, triggering factors, such as migraine attacks, emotional/physical stress, medications or vasoactive drugs may lead to sympathetic dysregulation and/or hyperresponsiveness causing sudden and prolonged vascular constriction resulting in hypoxic injury to vulnerable parenchyma 1,6 . As neuroimaging continues to improve, radiologic parallels between RCVS and posterior reversible encephalopathy syndrome (PRES) have been observed, suggesting the two are a continuum of disease rather than two independent disease entities, as PRES can present with similar radiologic findings and is associated with dysregulation of cerebral arterial tone; however, despite the shared clinical prodrome and radiologic features, the exact pathophysiology also remains elusive 10 .…”

Section: Discussionmentioning

confidence: 99%

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The link between reversible cerebral vasoconstriction syndrome and transient global amnesia

et al. 2023

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A 55-year-old male with a past medical history significant for anxiety (on fluvoxamine 100 mg daily for the past year), obstructive sleep apnea and intermittent use of pseudoephedrine as needed for congestion (last dose was 5 days prior to admission) presented to our tertiary care emergency department with a thunderclap headache (TCH) and sudden anterograde amnesia. At 7 days prior his admission, the patient was evaluated by his dentist for a toothache that was attributed to a possible infected tooth and was subsequently treated with amoxicillin-clavulanate. Then 3 days later, he presented to an emergency department (ED) with a severe holocranial TCH and was found to be hypertensive. A non-contrast computed tomography (NCCT) of his brain did not show any acute intracranial abnormalities. A CT angiogram (CTA) of the head and neck was also unremarkable. His headache was attributed to elevated blood pressure coupled with his recent history of a toothache and he was discharged from the ED on metoprolol. Despite medical management

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

The link between reversible cerebral vasoconstriction syndrome and transient global amnesia

et al. 2023

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“…It would also be interesting to perform repeated TOF-MRA imaging (in and after the amnestic episode) because reversible vasoconstriction in the context of TGA has been observed ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Vertebral artery hypoplasia and hemodynamic impairment in transient global amnesia: a case control study

Werner,

Ekstrom,

Kureck

et al. 2024

Front. Neurol.

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IntroductionThe aetiology of transient global amnesia (TGA) is still a matter of debate. Besides ischemia of the mesial temporal lobe including the hippocampus, migraine-like mechanisms, epileptic seizures affecting mnestic structures, or venous congestion in the (para) hippocampal area due to jugular vein insufficiency have been discussed. We assessed the diameters of the intracranial arteries of TGA patients compared to controls to identify differences that support the hypothesis of reduced hippocampal perfusion as a pivotal factor in the pathophysiology of TGA.MethodsWe reviewed magnetic resonance imaging time of flight angiographies (TOF-MRA) that were acquired during in-patient treatment of 206 patients with acute TGA.ResultsThe diameters of the vertebral artery (VA) in the V4 segment, the proximal basilar artery, and the internal carotid arteries were measured manually. We compared the findings with TOF-MRA images of an age and sex matched control group of neurological patients without known cerebrovascular pathology. In TGA patients the diameter of the right VA was significantly (p < 0.01) smaller compared to controls (2.09 mm vs. 2.35 mm). There were no significant differences in the diameters of the other vessels. Only the fetal variant of the posterior cerebral artery was slightly more common in TGA.DiscussionThe smaller diameter (hypoplasia) of the right VA supports the hypothesis of a contribution of hemodynamic factors to the pathophysiology of TGA. The fact that hypoplasia represents a congenital condition might be the explanation why previous studies failed to find an increased rate of the classical (acquired) vascular risk factors.

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“…B Passend zu einem RCVS zeigten sich in der MRA mehrere segmentale Vasokonstriktionen überwiegend im posterioren Stromgebiet. (AusKamm et al 2019) Therapiestudien liegen nicht vor. Steroide sind nicht wirksam(Miller et al 2015).…”

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Sekundäre Kopfschmerzsyndrome

Förderreuther¹,

Kamm²

2020

Klinische Neurologie

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Symptomatische oder sekundäre Kopfschmerzen sind keine eigenständige Erkrankung wie z. B. die Migräne, sondern Symptom einer anderen Grunderkrankung. Sekundäre Kopfschmerzen sind insgesamt deutlich seltener als primäre Kopfschmerzen und machen zusammen mit den Neuralgien etwa 8 % aller Kopfschmerzformen aus. Sekundäre Kopfschmerzen können unbehandelt zu einer erheblichen Morbidität oder sogar Mortalität führen und erfordern daher häufig sofortiges Handeln. Einige dieser Kopfschmerzformen, wie die Subarachnoidalblutung, können unerkannt bereits in kurzer Zeit letal enden oder wie im Falle einer unerkannten Sinusvenenthrombose oder Riesenzellarteriitis zu schweren neurologischen Schäden führen. Nicht immer ist die Diagnose einfach zu stellen, zumal das differenzialdiagnostische Spektrum der Erkrankungen, die mit Kopfschmerzen einhergehen, sehr breit ist und nicht alle Erkrankungen mit Routinebildgebung diagnostiziert werden können. Für das diagnostische Vorgehen sollte stets anhand der Anamnese und des Untersuchungsbefundes eine klinische Verdachtsdiagnose formuliert und entsprechend gezielte Zusatzdiagnostik veranlasst werden.

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RCVS and TGA: a common pathophysiology?

Cited by 9 publications

References 16 publications

The link between reversible cerebral vasoconstriction syndrome and transient global amnesia

The link between reversible cerebral vasoconstriction syndrome and transient global amnesia

Vertebral artery hypoplasia and hemodynamic impairment in transient global amnesia: a case control study

Sekundäre Kopfschmerzsyndrome

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