Transcranial color doppler study for reversible cerebral vasoconstriction syndromes

Shih Pin Chen, Jong Ling Fuh, Feng Chi Chang, Jiing Feng Lirng, Ben Chang Shia, Shuu Jiun Wang

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Objective: Reversible cerebral vasoconstriction syndromes (RCVS) are characterized by thunderclap headaches and reversible cerebral vasoconstrictions. No systematic studies on cerebral hemodynamics have been published. Methods: Patients with RCVS were consecutively recruited. Sequential transcranial color-coded sonography studies were performed on the middle cerebral artery (MCA) for 3 months. Mean flow velocities (VMCA) and Lindegaard Index (LI) were recorded and compared with those of controls. Results: Thirty-two patients (all female; average age, 49-7 ± 6.8 years) were enrolled. Four developed reversible posterior leukoencephalopathy syndrome, and two of them, ischemic strokes. One hundred and twenty-six sonography studies were performed on 57 eligible MCAs. The mean maximum VMCA (109.5 ± 30.8cm/sec) and LI (2.2 ± 0.7) of RCVS patients exceeded those of controls (VMCA: 66.3 ± 9.5cm/sec, p <0.001; LI: 1.4 ± 0.3, p <0.001). The VMCA and LI levels were still at their plateau at the mean time (day 22 after headache onset) of headache resolution. Fifteen (46.9%) patients had VMCA exceeding 120cm/sec, and 5 (16%) had LI exceeding 3. Patients fulfilling the criteria of subarachnoid hemorrhage mild vasospasm (n = 4; 13%), that is, both VMCA greater than 120cm/sec and LI greater than 3, had a greater risk of posterior leukoencephalopathy (75 vs 4%; p = 0.003) and ischemic strokes (50 vs 0%; p = 0.01) than those without. Interpretation: Patients with RCVS experienced prolonged vasoconstriction, making the risk for posterior leukoencephalopathy and ischemic strokes outlast headache resolution. Patients fulfilling mild vasospasm criteria for subarachnoid hemorrhage carry a high risk.

Original languageEnglish
Pages (from-to)751-757
Number of pages7
JournalAnnals of Neurology
Volume63
Issue number6
DOIs
Publication statusPublished - Jun 2008
Externally publishedYes

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Vasoconstriction
Color
Headache
Leukoencephalopathies
Stroke
Subarachnoid Hemorrhage
Ultrasonography
Posterior Leukoencephalopathy Syndrome
Primary Headache Disorders
Middle Cerebral Artery
Hemodynamics

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Transcranial color doppler study for reversible cerebral vasoconstriction syndromes. / Chen, Shih Pin; Fuh, Jong Ling; Chang, Feng Chi; Lirng, Jiing Feng; Shia, Ben Chang; Wang, Shuu Jiun.

In: Annals of Neurology, Vol. 63, No. 6, 06.2008, p. 751-757.

Research output: Contribution to journalArticle

Chen, Shih Pin ; Fuh, Jong Ling ; Chang, Feng Chi ; Lirng, Jiing Feng ; Shia, Ben Chang ; Wang, Shuu Jiun. / Transcranial color doppler study for reversible cerebral vasoconstriction syndromes. In: Annals of Neurology. 2008 ; Vol. 63, No. 6. pp. 751-757.
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abstract = "Objective: Reversible cerebral vasoconstriction syndromes (RCVS) are characterized by thunderclap headaches and reversible cerebral vasoconstrictions. No systematic studies on cerebral hemodynamics have been published. Methods: Patients with RCVS were consecutively recruited. Sequential transcranial color-coded sonography studies were performed on the middle cerebral artery (MCA) for 3 months. Mean flow velocities (VMCA) and Lindegaard Index (LI) were recorded and compared with those of controls. Results: Thirty-two patients (all female; average age, 49-7 ± 6.8 years) were enrolled. Four developed reversible posterior leukoencephalopathy syndrome, and two of them, ischemic strokes. One hundred and twenty-six sonography studies were performed on 57 eligible MCAs. The mean maximum VMCA (109.5 ± 30.8cm/sec) and LI (2.2 ± 0.7) of RCVS patients exceeded those of controls (VMCA: 66.3 ± 9.5cm/sec, p <0.001; LI: 1.4 ± 0.3, p <0.001). The VMCA and LI levels were still at their plateau at the mean time (day 22 after headache onset) of headache resolution. Fifteen (46.9{\%}) patients had VMCA exceeding 120cm/sec, and 5 (16{\%}) had LI exceeding 3. Patients fulfilling the criteria of subarachnoid hemorrhage mild vasospasm (n = 4; 13{\%}), that is, both VMCA greater than 120cm/sec and LI greater than 3, had a greater risk of posterior leukoencephalopathy (75 vs 4{\%}; p = 0.003) and ischemic strokes (50 vs 0{\%}; p = 0.01) than those without. Interpretation: Patients with RCVS experienced prolonged vasoconstriction, making the risk for posterior leukoencephalopathy and ischemic strokes outlast headache resolution. Patients fulfilling mild vasospasm criteria for subarachnoid hemorrhage carry a high risk.",
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AU - Chang, Feng Chi

AU - Lirng, Jiing Feng

AU - Shia, Ben Chang

AU - Wang, Shuu Jiun

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AB - Objective: Reversible cerebral vasoconstriction syndromes (RCVS) are characterized by thunderclap headaches and reversible cerebral vasoconstrictions. No systematic studies on cerebral hemodynamics have been published. Methods: Patients with RCVS were consecutively recruited. Sequential transcranial color-coded sonography studies were performed on the middle cerebral artery (MCA) for 3 months. Mean flow velocities (VMCA) and Lindegaard Index (LI) were recorded and compared with those of controls. Results: Thirty-two patients (all female; average age, 49-7 ± 6.8 years) were enrolled. Four developed reversible posterior leukoencephalopathy syndrome, and two of them, ischemic strokes. One hundred and twenty-six sonography studies were performed on 57 eligible MCAs. The mean maximum VMCA (109.5 ± 30.8cm/sec) and LI (2.2 ± 0.7) of RCVS patients exceeded those of controls (VMCA: 66.3 ± 9.5cm/sec, p <0.001; LI: 1.4 ± 0.3, p <0.001). The VMCA and LI levels were still at their plateau at the mean time (day 22 after headache onset) of headache resolution. Fifteen (46.9%) patients had VMCA exceeding 120cm/sec, and 5 (16%) had LI exceeding 3. Patients fulfilling the criteria of subarachnoid hemorrhage mild vasospasm (n = 4; 13%), that is, both VMCA greater than 120cm/sec and LI greater than 3, had a greater risk of posterior leukoencephalopathy (75 vs 4%; p = 0.003) and ischemic strokes (50 vs 0%; p = 0.01) than those without. Interpretation: Patients with RCVS experienced prolonged vasoconstriction, making the risk for posterior leukoencephalopathy and ischemic strokes outlast headache resolution. Patients fulfilling mild vasospasm criteria for subarachnoid hemorrhage carry a high risk.

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