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Angiographic Characteristics of Hemorrhagic and Ischemic Phases of Reversible Cerebral Vasoconstriction Syndrome

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Abstract

Purpose

This study aimed to assess the evolution of imaging patterns over time in patients with neurological complications caused by reversible cerebral vasoconstriction syndrome.

Methods

A total of 24 consecutive patients with reversible cerebral vasoconstriction syndrome presenting between 2009 and 2016 were included, whose disease course was complicated by intracranial hemorrhage and/or ischemic events. In total 55 angiographic studies were carried out. The nature of the intracranial complication and location of vasoconstriction on the angiograms in relation to the time interval since symptom-onset were assessed.

Results

Complications included subarachnoid hemorrhage (n = 19, 79%), intracerebral hemorrhage (n = 7, 29%), ischemic stroke (n = 6, 25%), and transient ischemic attack (n = 4, 17%). Hemorrhagic complications mainly occurred within 7 days after symptom onset (18/19 patients, 95%), whereas ischemic events only occurred after the first week (10/10 patients, 100%, p < 0.00001). Distal vasospasm was predominantly observed within 7 days (26/28 angiograms, 93%) and proximal vasospasm ≥7 days (23/27 angiograms, 85%, p < 0.00001).

Conclusion

In reversible cerebral vasoconstriction syndrome causing neurological complications, an early hemorrhagic phase with distal vasospasm and a delayed ischemic phase with proximal vasospasm can be discriminated.

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Authors and Affiliations

  1. Department of Medical Imaging, Division of Neuroradiology, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, Canada

    Bianzhi Xing, Stéphanie Lenck, Timo Krings & Jin Hengwei

  2. Department of Radiology, Renmin hospital, Wuhan University, No.9 ZhangZhiDong Street, Wuhan, Hubei, China

    Bianzhi Xing

  3. Department of Interventional Neuroradiology, Neurosurgical Institute/Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, 100050, Beijing, China

    Jin Hengwei

  4. Department of Medicine, Division of Neurology—Stroke Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, ON M5T 2S8, Toronto, Canada

    Cheryl S. Jaigobin & Joanna D. Schaafsma

Authors
  1. Bianzhi Xing
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  2. Stéphanie Lenck
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  3. Timo Krings
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  4. Jin Hengwei
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  5. Cheryl S. Jaigobin
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  6. Joanna D. Schaafsma
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Corresponding author

Correspondence to Joanna D. Schaafsma.

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Conflict of interest

B. Xing, S. Lenck, T. Krings, J. Hengwei, C.S. Jaigobin and J.D. Schaafsma declare that they have no competing interests.

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Xing, B., Lenck, S., Krings, T. et al. Angiographic Characteristics of Hemorrhagic and Ischemic Phases of Reversible Cerebral Vasoconstriction Syndrome. Clin Neuroradiol 30, 85–89 (2020). https://doi.org/10.1007/s00062-018-0736-7

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  • DOI: https://doi.org/10.1007/s00062-018-0736-7

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