Reversible Cerebral Vasoconstriction Syndrome Associated with Levonorgestrel-Releasing Intrauterine System

Abstract

Reversible cerebral vasoconstriction syndromes (RCVS) is a rare disease that is characterized by reversible multifocal stenosis of the cerebral arteries with various clinical manifestations. Though the pathomechanism of RCVS was unclear, we reported RCVS related to the levonorgestrel-releasing intrauterine system (IUS). A previous healthy 36-year-old woman had thunderclap headache after implanting the levonorgestrel-releasing IUS a year ago. In the serial angiography, we initially found left vertebra artery (VA), and then additionally new stenosis of both anterior cerebral arteries and middle cerebral arteries (MCA). Bilateral MCA stenosis improved but developed stenosis of right VA after a week. The mean flow velocities of both MCA increased in the first transcranial doppler (TCD), but normalized in the follow up TCD. Levonorgestrel might act as the vasoconstrictitve factor that increased the level of endothelin-1, diminished the release of NO and raised oxidative low-density lipoprotein (LDL). Although the exact pathological mechanisms for RCVS were not yet elucidated, this case might help clinicians understand the mechanisms of RCVS.

Pathophysiology of reversible cerebral vasoconstriction syndrome

“…However, direct evidence is lacking. In a few case reports, the occurrence of RCVS was associated with an acute withdrawal or administration of hormones, such as bilateral salpingo-oophorectomy [ 102 ], hormonal ovarian stimulation for intrauterine insemination [ 103 ], oral contraceptive pills [ 104 ], or levonorgestrel-releasing intrauterine system [ 105 ]. However, it is difficult to establish causality based on selected case reports.…”

Reversible cerebral vasoconstriction syndrome after levonorgestrel‐releasing intrauterine device placement—Case report

“…A recent case report demonstrated an association between the placement of a levonorgestrel IUD and the development of RCVS as seen in our case. 6 To our best knowledge, this is the second case report of RCVS related to a levonorgestrel-releasing IUD.…”

“…with a variety of conditions including pregnancy, migraine, use of vasoconstrictive drugs, and others. [1][2][3][4][5][6][7] Reversible cerebral vasoconstriction syndrome predominantly affects women, 8,9 especially during the postpartum period, with female-to-male ratios ranging from 2:1 to 10:1. 7,[10][11][12][13] This raises the…”

“…Reversible cerebral vasoconstriction syndrome (RCVS) is a disease characterized by reversible multifocal narrowing of the cerebral arteries with clinical manifestations that typically include thunderclap headache and occasionally brain edema, stroke, or seizure. Reversible cerebral vasoconstriction syndrome has been associated with a variety of conditions including pregnancy, migraine, use of vasoconstrictive drugs, and others 1–7 …”

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Reversible cerebral vasoconstriction syndrome (RCVS) is a disease characterized by reversible multifocal narrowing of the cerebral arteries with clinical manifestations that typically include thunderclap headache and occasionally brain edema, stroke, or seizure.

Reversible cerebral vasoconstriction syndrome has been associatedwith a variety of conditions including pregnancy, migraine, use of vasoconstrictive drugs, and others. [1][2][3][4][5][6][7] Reversible cerebral vasoconstriction syndrome predominantly affects women, 8,9 especially during the postpartum period, with female-to-male ratios ranging from 2:1 to 10:1. 7,[10][11][12][13] This raises the

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