title: Reversible cerebral vasoconstriction syndrome: Is it more than just cerebral vasoconstriction?
abstract: BACKGROUND
  Systemic vascular alterations have not been described in reversible cerebral vasoconstriction syndrome (RCVS). We present a case series of RCVS patients having cardiac dysfunction during ictus, with a subset showing complete resolution of cardiomyopathy.
  
  
  METHODS
  Retrospective case-series: Cardiac left ventricular ejection fraction (LVEF) and wall motion abnormalities (WMA) visualized on transthoracic echocardiography (TTE), performed during RCVS ictus and follow-up was analyzed.
  
  
  RESULTS
  Of 68 patients, 18 (26%) had a TTE performed around ictus. Three of 18 (17%) patients demonstrated WMA on initial TTE. All three patients were female without previous coronary artery disease or heart failure, and were asymptomatic from the cardiac dysfunction. WMA resolved completely on follow-up in Patients 1 and 2. Global LV dysfunction persisted for at least 90 days in Patient 3.
  
  
  CONCLUSIONS
  Although the exact pathophysiology of the cardiomyopathy is uncertain, it may be related to localized coronary vasoconstriction causing myocardial ischemia/infarction. Vasoconstriction may not be limited to the cerebral vasculature and may involve extracerebral organs. Cardiac ventricular abnormalities may be a part of the RCVS spectrum.
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, OH, USA.
authors.forename: Seby
authors.initials: S
authors.lastname: John
authors.affiliation: Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, OH, USA.
authors.forename: Rula A
authors.initials: RA
authors.lastname: Hajj-Ali
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, OH, USA.
authors.forename: David
authors.initials: D
authors.lastname: Min
authors.affiliation: Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, OH, USA.
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Calabrese
authors.affiliation: Department of Neurology, Cleveland Clinic, OH, USA.
authors.forename: Russell
authors.initials: R
authors.lastname: Cerejo
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, OH, USA uchinok@ccf.org.
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013577:Syndrome; D014661:Vasoconstriction / Q000502:physiology; D020301:Vasospasm, Intracranial / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*
keywords: Reversible cerebral vasoconstriction syndrome (RCVS); cardiomyopathy; heart-brain connection; stress-induced cardiomyopathy; transient