title: Repetitive use of intra-arterial verapamil in the treatment of reversible cerebral vasoconstriction syndrome.
abstract: Reversible cerebral vasoconstriction syndrome (RCVS) typically presents with recurrent thunderclap headaches and neurological deficits that are usually self-limiting. The intra-arterial (IA) use of vasodilators for RCVS has been reported for severe cases. Patients with RCVS have the potential for serious and permanent neurological deficits. It is a rare disorder, with a recent surge in the number of reports, and probably continues to be under-diagnosed. We report two patients with RCVS with severe neurological sequelae, treated in a large tertiary hospital. Both patients received high-dose cortico steroids due to the possibility of angiitis of the central nervous system, but they deteriorated neurologically, which suggests that steroids may have a deleterious effect in RCVS. Treatment with IA verapamil resulted in reversal of vasoconstriction, but multiple treatments were necessary. Therefore, IA administration of verapamil is a possible treatment for severe RCVS, but there is only limited sustained improvement in vasodilation that may require repetitive treatments with a currently undetermined optimal treatment interval.
authors: Department of Neurology and Clinical Neurosciences, Clinical Neurosciences Center, University of Utah Hospitals and Clinics, 175 N Medical Drive East, Salt Lake City 84132, UT, USA. kris.french@hsc.utah.edu
authors: Kris F
authors: KF
authors: French
authors: Robert E
authors: RE
authors: Hoesch
authors: Juliann
authors: J
authors: Allred
authors: Michael
authors: M
authors: Wilder
authors: A G
authors: AG
authors: Smith
authors: Kathleen B
authors: KB
authors: Digre
authors: Donald V
authors: DV
authors: La Barge
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D011859:Radiography; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014700:Verapamil / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D014700:Verapamil