title: Reversible cerebral vasoconstriction syndromes: analysis of 139 cases.
abstract: OBJECTIVE
  To compare the clinical, laboratory, and imaging features of patients with reversible cerebral vasoconstriction syndromes evaluated at 2 academic centers, compare subgroups, and investigate treatment effects.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Massachusetts General Hospital (n = 84) or Cleveland Clinic (n = 55).
  
  
  METHODS
  One hundred thirty-nine patients with reversible cerebral vasoconstriction syndromes.
  
  
  METHODS
  Clinical, laboratory, and imaging features; treatment; and outcomes.
  
  
  RESULTS
  The mean age was 42.5 years, and 81% were women. Onset with thunderclap headache was documented in 85% and 43% developed neurological deficits. Prior migraine was documented in 40%, vasoconstrictive drug exposure in 42%, and recent pregnancy in 9%. Admission computed tomography or magnetic resonance imaging was normal in 55%; however, 81% ultimately developed brain lesions including infarcts (39%), convexity subarachnoid hemorrhage (34%), lobar hemorrhage (20%), and brain edema (38%). Cerebral angiographic abnormalities typically normalized within 2 months. Nearly 90% had good clinical outcome; 9% developed severe deficits; and 2% died. In the combined cohort, calcium channel blocker therapy and symptomatic therapy alone showed no significant effect on outcome; however, glucocorticoid therapy showed a trend for poor outcome (P = .08). Subgroup comparisons based on prior headache status and identified triggers (vasoconstrictive drugs, pregnancy, other) showed no major differences.
  
  
  CONCLUSIONS
  Patients with reversible cerebral vasoconstriction syndromes have a unique set of clinical imaging features, with no significant differences between subgroups. Prospective studies are warranted to determine the effects of empirical treatment with calcium channel blockers and glucocorticoids.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, 02114, USA. asinghal@partners.org
authors.forename: Aneesh B
authors.initials: AB
authors.lastname: Singhal
authors.forename: Rula A
authors.initials: RA
authors.lastname: Hajj-Ali
authors.forename: Mehmet A
authors.initials: MA
authors.lastname: Topcuoglu
authors.forename: Joshua
authors.initials: J
authors.lastname: Fok
authors.forename: James
authors.initials: J
authors.lastname: Bena
authors.forename: Donsheng
authors.initials: D
authors.lastname: Yang
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Calabrese
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult