rcvs vs pres
JAMA Neurol. In the final multivariable model, the timing of treatment was independently associated with the length of clinical courses (adjusted HR = 0.75 per 1-day in delay in treatment; 95% CI, 0.693–0.802; p < 0.001). The extent of vasoconstriction was associated with a longer clinical course, but statistical significance was not reached (adjusted HR = 0.94 for each vasoconstricted segment; 95% CI, 0.874–1.006; p = 0.075). 0000020192 00000 n If the natural course is the only determinant of the duration (time from onset to remission) of recurrent TCHs, the clinical course may be similar regardless of the timing of nimodipine treatment. This proportion was higher than expected because only a minority of patients with RCVS had a single TCH in the literature (4, 6, 7). 5 references maximum. Saving You Time. 0000051086 00000 n After referral, a combination of lumbar puncture, brain MRI, MR angiogram (MRA), and occasionally transfemoral cerebral angiography was performed for the differential diagnosis. Results: In 82 patients included in this study, 71 (86.6%) patients showed remission of TCHs after starting nimodipine treatment. x�b```b`��``c`�kea@ ������ \j�]@j�X��/�}d�����a��E�ʕ3��Y. 0000055023 00000 n Choi HA, Lee MJ, Choi H, Chung CS. The initiation of nimodipine treatment is marked with a red arrow. 0000028456 00000 n RCVS is treated with observation or possibly calcium channel blockers, whereas CNS vasculitis is treated with steroids and immunosuppression.1 However, the diagnosis of RCVS is currently confirmed only in retrospect, when arterial narrowing resolves. The incidence of PRES is unknown. Patients completed a structured questionnaire on headache characteristics specifically designed for the evaluation of TCHs. PRES-like reversible cerebral edema is encountered in anywhere from 9% to 38% of patients with RCVS, while most patients with PRES (>85%) demonstrate some element of RCVS-like cerebral vasoconstriction when conventional angiography is performed. 0000052304 00000 n In addition, the large number of patients is another strength. Among 11 patients (13.4%) who had recurrent TCHs despite treatment, the dose of nimodipine was increased in seven patients (8.5%). 3,5 Additionally, catheter-based digital subtraction angiography is frequently normal with PACNS, while it is by definition always abnormal with RCVS. The time of each thunderclap headache (TCH) is marked as a black arrow. From the ER, patients with acute onset severe headache were referred to a neurologist after aneurysmal subarachnoid hemorrhage (SAH) was excluded based on non-contrast brain CT and post-contrast CT angiogram findings. Systemic blood pressure was followed-up in all patients at a median of 16 (IQR 10–30) days after treatment. Anecdotal evidence suggests that the number of patients presenting with PRES and RCVS is increasing. If vasoconstrictions were not normalized, neuroimaging was followed-up at 6 months with treatment being continued. This might have been due to selective effects of nimodipine on cerebral vessels (2, 4). Dodick DW, Brown RD Jr, Britton JW, Huston J III. Nimodipine for treatment of primary thunderclap headache. Fourth, we did not use the total number of TCHs as outcome variables because several patients could not exactly recall it particularly when they had numerous attacks. Patient demographics and characteristics, neurological complications, extent of vasoconstriction, and remission rates were compared according to the tertiles of time from onset to treatment. “We need to do better at recognizing and treating these disorders urgently to prevent permanent neurologic injury,” said Anne O’Duffy, MD. We also assessed neurological complications such as seizure, ischemic stroke, cortical SAH, and PRES. We prospectively screened patients with TCHs who visited Samsung Medical Center, Seoul, South Korea from October 2015 to January 2018. Neurologists should strongly consider a diagnosis of RCVS for a patient with repeated thunderclap headaches during a period of several days to a week, said Dr. O’Duffy. (1993) 238:131–3. The international classification of headache disorders, (beta version). We tested if nimodipine treatment prevents the recurrence of TCHs and whether the timing (early vs. late) of treatment affects the clinical course (i.e., time from onset to remission of TCH) in RCVS. In our study, initial treatment was started at a dose of 30 mg every 8–12 h per day (median, 1.5 mg/kg/day). (A) Non-response: TCHs did not remit immediately after the nimodipine administration (B) Response: TCHs remitted after the nimodipine administration. doi: 10.1161/STROKEAHA.109.572313, 7. Stroke. The study received ethical approval from The Samsung Medical Center Institutional Review Board. RCVS can occur spontaneously or result from various exogenous or endogenous factors such as catecholamines, serotonin, nitric oxide, prostaglandins, and various inflammatory agents. 0000005907 00000 n According to ICHD-3 beta, headache attributed to RCVS is manifested as typically recurrent TCHs, at least one TCH triggered by the typical precipitants and no recurrence of significant headache after 1 month.
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