Kumar Neha, Kumar Sandeep, Rocha Eva, Lioutas Vasileios-Arsenios
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil.
J Neurol. 2023 Mar;270(3):1647-1653. doi: 10.1007/s00415-022-11511-2. Epub 2022 Dec 6.
Angiographic vasoconstriction in reversible cerebral vasoconstriction syndrome (RCVS) is often undetectable at symptom onset and the diagnosis relies on clinical presentation. Although thunderclap headache is a hallmark feature of RCVS, the incidence and predictors of long-term headaches (LTH) are incompletely understood. Our study aims were twofold: to examine the sensitivity and specificity of a recently developed score (RCVS) for vasoconstriction detection in a real-world clinical context and describe the incidence and predictors of LTH beyond the acute phase of RCVS.
Retrospective analysis of consecutive patients with clinical diagnosis of RCVS in a tertiary hospital between 2017 and 2021. We examined associations between demographic factors, comorbidities, medications, imaging characteristics, and LTH (defined as at least one episode present at greater than 6-months follow-up necessitating medication). We separately examined the association between RCVS score and angiographic vasoconstriction and computed its sensitivity, specificity, and negative and positive predictive value based on established cutoffs (certain ≥ 5, negative ≤ 2).
We included 55 patients, 50.5 (± 13.7) years; 41 (75%) female. 25 (49%) patients had LTH; only prior history of headache was significantly associated with LTH [OR 4.3, 95% CI (1.1-16.2), p = 0.03]. We found a significant association between RCVS score and angiographic vasoconstriction [OR 1.49, 95% CI (1.18-1.88), p = 0.001]; sensitivity, specificity, and positive and negative predictive value were 64%, 94%, 95% and 58% respectively.
Approximately 50% of RCVS patients experienced LTH; only prior headache history was associated with its incidence. The RCVS2 score had a significant association with high specificity and positive predictive value for angiographic vasoconstriction in our cohort, validating its utility in improving the accuracy of diagnosis in the clinical setting.
可逆性脑血管收缩综合征（RCVS）中的血管造影血管收缩在症状发作时通常无法检测到，诊断依赖于临床表现。尽管霹雳样头痛是RCVS的标志性特征，但长期头痛（LTH）的发生率和预测因素尚未完全明确。我们的研究目的有两个：在真实临床环境中检验最近开发的用于血管收缩检测的评分（RCVS）的敏感性和特异性，并描述RCVS急性期后LTH的发生率和预测因素。
对2017年至2021年期间在一家三级医院临床诊断为RCVS的连续患者进行回顾性分析。我们研究了人口统计学因素、合并症、药物治疗、影像学特征与LTH（定义为在随访超过6个月时至少出现一次需要药物治疗的发作）之间的关联。我们分别研究了RCVS评分与血管造影血管收缩之间的关联，并根据既定临界值（肯定≥5，否定≤2）计算其敏感性、特异性以及阴性和阳性预测值。
我们纳入了55例患者，年龄50.5（±13.7）岁；41例（75%）为女性。25例（49%）患者有LTH；只有既往头痛史与LTH显著相关[比值比4.3，95%置信区间（1.1 - 16.2），p = 0.03]。我们发现RCVS评分与血管造影血管收缩之间存在显著关联[比值比1.49，95%置信区间（1.18 - 1.88），p = 0.001]；敏感性、特异性以及阳性和阴性预测值分别为64%、94%、95%和58%。
约50%的RCVS患者经历过LTH；只有既往头痛史与其发生率相关。在我们的队列中，RCVS2评分与血管造影血管收缩具有显著关联，特异性和阳性预测值较高，验证了其在提高临床诊断准确性方面的效用。
