Hemorrhagic manifestations of reversible cerebral vasoconstriction syndrome: frequency, features, and risk factors.
OBJECTIVE
Reversible cerebral vasoconstriction syndrome (RCVS), characterized by severe headaches and reversible constriction of cerebral arteries, may be associated with ischemic and hemorrhagic strokes. The aim of this study was to describe the frequency, patterns, and risk factors of intracranial hemorrhages in RCVS.


METHODS
We analyzed prospective data on 89 consecutive patients with RCVS, of which 8 were postpartum and 46 used vasoactive substances. Standard bivariate and multivariate statistical tests were applied to compare patients with and without hemorrhage.


RESULTS
Thirty patients (34%), of which 5 were postpartum and 12 used vasoactive substances, developed at least 1 type of intracranial hemorrhage, including cortical subarachnoid (n = 27), intracerebral (n = 11), and subdural hemorrhage (n=2). Patients with hemorrhage had an older age (46.6 versus 41.6 years, P = 0.049) and were more frequently females (90% versus 51%, P = 0.0017) or were migrainers (43% versus 19%, P = 0.022) than those without hemorrhage. Multivariate testing identified 2 independent risk factors of hemorrhage in RCVS: female gender (OR, 4.05; 95% CI, 1.46 to 11.2) and migraine (OR, 2.34; 95% CI, 1.06 to 5.18). Patients with hemorrhage had a greater risk of persistent focal deficits (30% versus 2%, P = 0.0002), cerebral infarction (13% versus 2%, P = 0.039), posterior reversible encephalopathy syndrome (17% versus 3%, P = 0.041) at the acute stage, and of inability to resume normal activities at 6 months (27% versus 0%, P < 0.0001).


CONCLUSIONS
In RCVS, women and migrainers seem to be at higher risk of intracranial hemorrhage. Overall, intracranial hemorrhages are frequent in RCVS and are associated with a more severe clinical spectrum.
Ducros
Anne
A
Emergency Headache Center Head and Neck Clinic, Lariboisière Hospital, Paris, France. anne.ducros@lrb.aphp.fr
Fiedler
Ursula
U
Porcher
Raphael
R
Boukobza
Monique
M
Stapf
Christian
C
Bousser
Marie-Germaine
MG
D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D002539:Cerebral Arterial Diseases / Q000150:complications* / Q000175:diagnosis; D005260:Female; D051270:Headache Disorders, Primary / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D020300:Intracranial Hemorrhages / Q000145:classification* / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications; D009422:Nervous System Diseases / Q000150:complications* / Q000175:diagnosis; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D013577:Syndrome; D014057:Tomography, X-Ray Computed