Verapamil in the treatment of reversible cerebral vasoconstriction syndrome: A systematic review

Collins, Louise; Lam, Lydia; Kleinig, Oliver; Proudman, W. D.; Zhang, R; Bagster, Michelle; Kovoor, Joshua G; Gupta, Aashray K.; Goh, Rudy; Bacchi, Stephen; Schultz, David; Kleinig, Timothy

doi:10.1016/j.jocn.2023.05.013

Cited by 3 publications

(1 citation statement)

References 65 publications

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“…Verapamil belongs to Ca(2+) channel blockers. A recent systematic review highlighted that there are no randomized trials to support the routine use of verapamil in vasospasm and DCI, although observational data suggest possible clinical but underestimated benefits [ 22 ]. On a cohort series of 75 procedures from Burdenko Institute of Neurosurgery, intra-arterial verapamil proved to be effective in patients in the initial stage of DCI [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia

Luzzi,

Bektaşoğlu,

Doğruel

et al. 2024

Neurosurg Rev

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The clinical management of aneurysmal subarachnoid hemorrhage (SAH)-associated vasospasm remains a challenge in neurosurgical practice, with its prevention and treatment having a major impact on neurological outcome. While considered a mainstay, nimodipine is burdened by some non-negligible limitations that make it still a suboptimal candidate of pharmacotherapy for SAH. This narrative review aims to provide an update on the pharmacodynamics, pharmacokinetics, overall evidence, and strength of recommendation of nimodipine alternative drugs for aneurysmal SAH-associated vasospasm and delayed cerebral ischemia. A PRISMA literature search was performed in the PubMed/Medline, Web of Science, ClinicalTrials.gov, and PubChem databases using a combination of the MeSH terms “medical therapy,” “management,” “cerebral vasospasm,” “subarachnoid hemorrhage,” and “delayed cerebral ischemia.” Collected articles were reviewed for typology and relevance prior to final inclusion. A total of 346 articles were initially collected. The identification, screening, eligibility, and inclusion process resulted in the selection of 59 studies. Nicardipine and cilostazol, which have longer half-lives than nimodipine, had robust evidence of efficacy and safety. Eicosapentaenoic acid, dapsone and clazosentan showed a good balance between effectiveness and favorable pharmacokinetics. Combinations between different drug classes have been studied to a very limited extent. Nicardipine, cilostazol, Rho-kinase inhibitors, and clazosentan proved their better pharmacokinetic profiles compared with nimodipine without prejudice with effective and safe neuroprotective role. However, the number of trials conducted is significantly lower than for nimodipine. Aneurysmal SAH-associated vasospasm remains an area of ongoing preclinical and clinical research where the search for new drugs or associations is critical.

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Section: Resultsmentioning

confidence: 99%

Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia

Luzzi,

Bektaşoğlu,

Doğruel

et al. 2024

Neurosurg Rev

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Predictors of angiographic resolution in patients with presumed reversible cerebral vasoconstriction syndrome

Madapoosi,

McGuire,

Hossa

et al. 2024

Interv Neuroradiol

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Introduction Reversible cerebral vasoconstriction syndrome is a complex neurovascular syndrome that presents with varying neurological deficits as well as segmental vasoconstriction of the small and medium cerebral arteries. There is limited literature on pathologies that mimic reversible cerebral vasoconstriction syndrome, so this study aims to understand what factors may impact the angiographic confirmation of reversible cerebral vasoconstriction syndrome on follow-up and play a role in establishing the diagnosis. Methods The Clinical Research Data Warehouse at this institution was employed to search the medical records for patients with diagnosis and treatment of reversible cerebral vasoconstriction syndrome between January 2010 and May 2021. After screening, 32 patients met the inclusion criteria for a presumed diagnosis of reversible cerebral vasoconstriction syndrome with both angiography on presentation and at three-month follow-up after treatment. Patients were divided into two categories: those with complete angiographic resolution, versus partial or no improvement on follow-up. Clinical and radiographic data were analyzed. Results Patients who had partial or no resolution were more likely to have a history of hypertension ( p = 0.001), higher systolic blood pressure on admission ( p = 0.047), and present with a recurrent thunderclap headache ( p = 0.038). Binary logistic regression selected for hypertension (odds ratio [OR] 18.35 [95% CI, 1.37–245.1]) as predictive of not having reversible cerebral vasoconstriction syndrome, as can be seen by partial or no resolution on follow-up angiography ( p = 0.028). Conclusion Complete resolution on follow-up angiography is a distinguishing factor of reversible cerebral vasoconstriction syndrome. Our analysis revealed that a history of hypertension is the most significant predictor of confirming that a patient may not have reversible cerebral vasoconstriction syndrome. This is due, in part, to increased atherosclerotic or hypertensive cerebral arterial changes, which can mimic reversible cerebral vasoconstriction syndrome and present as partial or no resolution on angiography.

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Reversible cerebral vasoconstriction syndrome developed during treatment of Parkinson's disease with rasagiline mesylate: A case report

Nakaya,

Kaneko,

Matsumoto

et al. 2024

Cephalalgia Reports

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Background Rasagiline mesylate, a monoamine oxidase-B inhibitor, is used in Parkinson's disease (PD) treatment. We report a case of reversible cerebral vasoconstriction syndrome (RCVS) developed after rasagiline mesylate initiation. Case presentation A 59-year-old woman was diagnosed with PD at the age of 54 years. She experienced frequent episodes of nausea after increasing the dose of levodopa-carbidopa hydrate, and her nausea worsened with the addition of rasagiline mesylate. Three months later, the patient experienced recurrent thunderclap headaches. Brain imaging revealed subarachnoid hemorrhage with segmental vasoconstriction in the main trunks of multiple cerebral arteries. The subsequent clinical course was consistent with RCVS. Her headache and nausea were completely resolved by the discontinuation of rasagiline mesylate and addition of verapamil hydrochloride. Discussion Worsened nausea was the only sign implicating the elevated monoamine levels, potentially linked to the development of RCVS. RCVS should be considered when a patient taking rasagiline mesylate experiences thunderclap headache.

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Verapamil in the treatment of reversible cerebral vasoconstriction syndrome: A systematic review

Cited by 3 publications

References 65 publications

Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia

Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia

Predictors of angiographic resolution in patients with presumed reversible cerebral vasoconstriction syndrome

Reversible cerebral vasoconstriction syndrome developed during treatment of Parkinson's disease with rasagiline mesylate: A case report

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