Reversible Cerebral Vasoconstriction Syndrome Triggered by Typhoon Hagibis in 2019: Report of 2 Cases

Abstract

Although reversible cerebral vasoconstriction syndrome (RCVS) is a relatively rare condition, we encountered 2 consecutive patients with RCVS during Typhoon Hagibis in 2019. The first patient developed headache when the atmospheric pressure rapidly fell, and the second patient developed headache when the atmospheric pressure rapidly rose. Extreme atmospheric pressure fluctuations might induce neuronal activity in the trigeminal nucleus caudalis and sympathetic activation. Our experience with these 2 patients indicates the importance of magnetic resonance angiography for individuals with thunderclap headache during a typhoon.

Reversible cerebral vasoconstriction syndrome: literature review

“…The largest studies suggest that 50–80% of patients will have a secondary cause for RCVS [ 1 , 10 , 19 , 35 , 41 , 44 ]. The main precipitating factors described are: postpartum state [ 7 , 10 , 13 , 14 , 16 , 25 , 31 , 35 , 39 , 45 – 47 ], drugs with vasoactive properties [ 10 , 12 – 14 , 36 , 39 , 47 , 48 ], such as cocaine, marijuana, and heroin [ 33 , 39 ], catecholamine-secreting tumors [ 35 , 49 – 51 ], autoimmune disorders, such as systemic vasculitis, systemic lupus erythematous, antiphospholipid syndrome [ 13 ], blood transfusions, ginseng [ 5 , 6 ], sexual intercourse, temperature differences (baths too hot or too cold), air travel [ 39 , 48 ], Corona Virus Disease 2019 (COVID-19) infection [ 36 , 52 – 54 ] and medications [ 6 , 29 , 39 , 48 ].…”

“…Resonance angiography and CT angiography are alternatives used [ 1 , 14 ], despite the possibility of not detecting abnormalities in small-caliber vessels [ 9 ]. Studies suggest that arteries with smaller calibers are affected first [ 13 , 20 , 35 , 41 , 66 ], so imaging tests may be normal initially [ 3 , 10 , 13 , 34 , 41 , 67 ]; therefore, early angiographic evaluation may be negative in up to 20% of patients with RCVS [ 3 , 5 , 34 ]. For this reason, it is recommended that angiography be performed within 2–3 weeks of the onset of symptoms, a period in which cerebral vasoconstriction is at its maximum [ 36 , 67 ].…”