Magnetic resonance angiography in reversible cerebral vasoconstriction syndromes.
OBJECTIVE
To investigate the evolution and clinical significance of vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral vasoconstriction syndromes (RCVS).


METHODS
Patients with RCVS were recruited and followed up with MRA examinations until normalization of vasoconstriction or for 6 months. The vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0-<10%), 1 (10-<25%), 2 (25-<50%), 3 (50-<75%), and 4 (> or =75%). Subjects with at least 1 segment with a vasoconstriction score > or =2 were eligible for the study. Initial mean scores of single or combined arterial segments were used to predict ischemic complications.


RESULTS
Seventy-seven patients with RCVS (8 men/69 women; average age 47.7 +/- 11.6 years) finished the study with a total of 225 MRAs performed. The mean number of arterial segments involved was 5.3 +/- 3.0 in the initial MRA. Vasoconstriction scores reached their maximum 16.3 +/- 10.2 days after headache onset, close to the average timing of headache resolution (16.7 +/- 8.6 days). Vasoconstriction evolved in a parallel trend among different arterial segments. Seven (9.1%) patients developed posterior reversible encephalopathy syndromes (PRES). Six (7.8%) patients had ischemic stroke. A logistic regression model demonstrated that the M1-P2 combined score was associated with highest risk of PRES (odds ratio [OR], 11.6, p = 0.005) and ischemic stroke (OR, 3.4; p = 0.026).


CONCLUSIONS
MRA evaluation in patients with RCVS is valid. Vasoconstriction was pervasive and outlasted headache resolution. Vasoconstrictions in M1 and P2 are important determinants for PRES and ischemic stroke.
Chen
Shih-Pin
SP
Institute of Clinical Medicine, Fu-Jen Catholic University, Taipei, Taiwan.
Fuh
Jong-Ling
JL
Wang
Shuu-Jiun
SJ
Chang
Feng-Chi
FC
Lirng
Jiing-Feng
JF
Fang
Ying-Chen
YC
Shia
Ben-Chang
BC
Wu
Jaw-Ching
JC
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000000981:diagnostic imaging*; D003251:Constriction, Pathologic / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods