Madapoosi Adrusht, McGuire Laura Stone, Fuentes Angelica, Tshibangu Mpuekela, Theiss Peter, Mrad Tatiana Abou, Amin-Hanjani Sepideh, Alaraj Ali
Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA.
Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Interv Neuroradiol. 2024 Sep 23:15910199241285501. doi: 10.1177/15910199241285501.
Reversible cerebral vasoconstriction syndrome (RCVS) can present with hemorrhage, ischemia, or both. We aim to compare the differences in presentation and outcomes between patients with RCVS.
The hemorrhagic presentation group had 58 patients, and the non-hemorrhagic presentations had 30 patients. Subgroup analysis compared patients with evidence of one or more types of hemorrhage ( = 53), no evidence of hemorrhage or infarction ( = 23), evidence of infarction only ( = 7), and combination of hemorrhage and infarction ( = 5). Clinical and radiographic data were analyzed.
Migraine ( = 0.030) and intracranial tumors ( = 0.004) were more frequent in non-hemorrhagic presentation. Seizures on admission ( = 0.047) and higher than average C-reactive protein (CRP) ( = 0.037) were seen at a higher rate in patients with hemorrhagic presentation. RCVS2 scores were not unexpectedly higher in patients with hemorrhage than non-hemorrhagic presentations ( = 0.010). Outcomes between the hemorrhagic and non-hemorrhagic groups were comparable. Subgroup analysis found a higher subset of patients with opiate use ( = 0.046) in the hemorrhage-only group. Patients with hemorrhage presented with a thunderclap headache ( < 0.001) more often when compared to the other three groups. RCVS2 score was not unexpectedly higher in the hemorrhage-only group compared with the other groups ( = 0.004).
A history of migraines was associated with ischemia, while intracranial tumor was significantly associated with evidence of either an infarct, or no changes on imaging. Exposure to opiates, and seizures or thunderclap headache on presentation were associated with hemorrhage. If our data are reproducible, the RCVS2 score may benefit from inclusion of other, small hemorrhages as criterion for diagnosis for RCVS.
可逆性脑血管收缩综合征（RCVS）可表现为出血、缺血或两者皆有。我们旨在比较RCVS患者在临床表现和预后方面的差异。
出血表现组有58例患者，非出血表现组有30例患者。亚组分析比较了有一处或多处出血证据的患者（n = 53）、无出血或梗死证据的患者（n = 23）、仅有梗死证据的患者（n = 7）以及出血和梗死并存的患者（n = 5）。对临床和影像学数据进行了分析。
偏头痛（P = 0.030）和颅内肿瘤（P = 0.004）在非出血表现中更为常见。出血表现的患者入院时癫痫发作（P = 0.047）和高于平均水平的C反应蛋白（CRP）（P = 0.037）发生率更高。出血患者的RCVS2评分高于非出血表现患者，这在意料之中（P = 0.010）。出血组和非出血组的预后相当。亚组分析发现，单纯出血组中使用阿片类药物的患者比例更高（P = 0.046）。与其他三组相比，出血患者更常出现霹雳样头痛（P < 0.001）。单纯出血组的RCVS2评分高于其他组，这在意料之中（P = 0.004）。
偏头痛病史与缺血有关，而颅内肿瘤与梗死证据或影像学无变化显著相关。使用阿片类药物以及就诊时癫痫发作或霹雳样头痛与出血有关。如果我们的数据具有可重复性，RCVS2评分可能会受益于纳入其他小出血作为RCVS诊断标准。
