67 - REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROMES

Summary

Cerebral vasoconstriction has been associated with several diverse conditions, including pregnancy, vasoconstrictive drugs, and headache disorders. While there may be differences in the etiopathogenesis of cerebral vasoconstriction with each associated condition, the clinical, laboratory, imaging, and angiographic features of these patients are remarkably similar, justifying the use of the inclusive term reversible cerebral vasoconstriction syndromes (RCVS). The RCVS affects women more often than men. The most frequent head CT or brain MRI abnormality is bihemispheric, symmetric infarcts in arterial borderzone regions. Serum calcium, and in some instances parathyroid hormone, levels should be drawn because hypercalcemia is a known cause of cerebral vasoconstriction and can cause strokes. The differential diagnosis primarily includes disorders that present with acute, severe thunderclap headache, which can be excluded with appropriate brain and vascular imaging. Calcium-channel blockers such as verapamil, nimodipine, and nicardipine show more effects on cervico-cranial arteries.