| Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. | |
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MedLine Citation:
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PMID: 21482916 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To compare the clinical, laboratory, and imaging features of patients with reversible cerebral vasoconstriction syndromes evaluated at 2 academic centers, compare subgroups, and investigate treatment effects. DESIGN: Retrospective analysis. SETTING: Massachusetts General Hospital (n = 84) or Cleveland Clinic (n = 55). PATIENTS: One hundred thirty-nine patients with reversible cerebral vasoconstriction syndromes. MAIN OUTCOME MEASURES: Clinical, laboratory, and imaging features; treatment; and outcomes. RESULTS: The mean age was 42.5 years, and 81% were women. Onset with thunderclap headache was documented in 85% and 43% developed neurological deficits. Prior migraine was documented in 40%, vasoconstrictive drug exposure in 42%, and recent pregnancy in 9%. Admission computed tomography or magnetic resonance imaging was normal in 55%; however, 81% ultimately developed brain lesions including infarcts (39%), convexity subarachnoid hemorrhage (34%), lobar hemorrhage (20%), and brain edema (38%). Cerebral angiographic abnormalities typically normalized within 2 months. Nearly 90% had good clinical outcome; 9% developed severe deficits; and 2% died. In the combined cohort, calcium channel blocker therapy and symptomatic therapy alone showed no significant effect on outcome; however, glucocorticoid therapy showed a trend for poor outcome (P = .08). Subgroup comparisons based on prior headache status and identified triggers (vasoconstrictive drugs, pregnancy, other) showed no major differences. CONCLUSION: Patients with reversible cerebral vasoconstriction syndromes have a unique set of clinical imaging features, with no significant differences between subgroups. Prospective studies are warranted to determine the effects of empirical treatment with calcium channel blockers and glucocorticoids. |
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Authors:
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Aneesh B Singhal; Rula A Hajj-Ali; Mehmet A Topcuoglu; Joshua Fok; James Bena; Donsheng Yang; Leonard H Calabrese |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural Date: 2011-04-11 |
Journal Detail:
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Title: Archives of neurology Volume: 68 ISSN: 1538-3687 ISO Abbreviation: Arch. Neurol. Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-08-09 Completed Date: 2011-10-13 Revised Date: 2012-01-19 |
Medline Journal Info:
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Nlm Unique ID: 0372436 Medline TA: Arch Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 1005-12 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurology, Massachusetts General Hospital, Boston, 02114, USA. asinghal@partners.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Cerebrovascular Disorders / diagnosis*, epidemiology*, therapy Cohort Studies Comorbidity Female Humans Male Middle Aged Retrospective Studies Syndrome Treatment Outcome Vasospasm, Intracranial / diagnosis*, epidemiology*, therapy Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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5R01NS38477/NS/NINDS NIH HHS; P01 NS035611/NS/NINDS NIH HHS; P50NS051343/NS/NINDS NIH HHS; R01NS051412/NS/NINDS NIH HHS; R01NS059775/NS/NINDS NIH HHS; R21NS061119/NS/NINDS NIH HHS |
| Comments/Corrections | |
Comment In:
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Arch Neurol. 2011 Dec;68(12):1614-5; author reply 1615
[PMID:
22159067
]
Arch Neurol. 2011 Aug;68(8):976-7 [PMID: 21825234 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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