Reversible cerebral vasoconstriction syndrome and migraine: sonography study.

RCVS is characterized by severe headaches with or without focal neurologic deficits and segmental constriction of cerebral arteries that resolves within 3 months. The primary clinical manifestation is recurrent sudden-onset and thunderclap headache. Diagnosis requires cerebral or magnetic resonance angiography (MRA) confirmation and ultrasound monitoring. Our purpose is to discover the difference of ultrasound data between RCVS and migraine. 61 patients (age range 17-60y., 41-female, 20-male) underwent sonography examination using Transcranial Dopplerography (TCD) and Transcranial Color-Coded Duplex Sonography (TCCD) methods. In 29 patients MRA examinations were performed. Group I- 27 patients with RCVS with typical acute-onset of severe headaches. Group II-34 patients- migraine in anamnesis, with 1-2 attacks monthly, control group -15 healthy persons. Ultrasound examinations were performed during 2 months with time intervals of 1-20, 21-40, and 41-60 days. Markedly in migraine group examinations were performed in interictal periods also. Group I-the mean maximum (MM) V(CS)-77,8 ± 14,7 cm/sec, V(MCA)- 127,5 ± 22.8 cm/sec, V(ACA) -115.7 ± 18.4, V(BA)- 74.7 ± 20.1. Lindegaard Index (LI) -3.1 ± 0.5. MRA revealed segmental cerebral artery vasoconstriction. The MCA was involved in 62.9%, the ACA- in 51.8%, the PCA- in 37% and the BAS- in 40.7% of patients. Group II- the MM V (CS)-72.8 ± 12.5 cm/sec, V (MCA)- 118,4 ± 26.7 cm/sec, V(ACA) -105.8 ± 17.6, V(BA)- 74.5 ± 18.1, averaged LI -2,9 ± 0.7. In the majority (61.7%) of this group revealed increased MM V in several cerebral arteries with different combination of involving vessels. No correlation was found between incidence side of pain and /or pain intensity. Both groups exceeded of controls -V (MCA) (63.2 ± 9.5 cm/sec), LI (2.1 ± 0.2), p<0.001) and revealed vasospasm. All data were calculated by nonparametric Binomial test. Obtained data showed no significant difference regarding the vasospasm degree between typical RCVS and migraine, whereas revealed that vasospasm in migraine is more determined to posterior circulation but in RCVS vasospasm has the more diffuse character. Despite the extensive knowledge concerning RCVS and migraine, many uncertainties still exist and further randomized controlled trials are needed for understanding the underlying pathophysiology factors.