title: Centripetal Propagation of Vasoconstriction at the Time of Headache Resolution in Patients with Reversible Cerebral Vasoconstriction Syndrome.
abstract: Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache and diffuse segmental vasoconstriction that resolves spontaneously within 3 months. Previous reports have proposed that vasoconstriction first involves small distal arteries and then progresses toward major vessels at the time of thunderclap headache remission. The purpose of this study was to confirm centripetal propagation of vasoconstriction on MRA at the time of thunderclap headache remission compared with MRA at the time of reversible cerebral vasoconstriction syndrome onset.
  
  
  
  Of the 39 patients diagnosed with reversible cerebral vasoconstriction syndrome at our hospital during the study period, participants comprised the 16 patients who underwent MR imaging, including MRA, within 72 hours of reversible cerebral vasoconstriction syndrome onset (initial MRA) and within 48 hours of thunderclap headache remission.
  
  
  
  In 14 of the 16 patients (87.5%), centripetal propagation of vasoconstriction occurred from the initial MRA to remission of thunderclap headache, with typical segmental vasoconstriction of major vessels. These mainly involved the M1 portion of the MCA (10 cases), P1 portion of the posterior cerebral artery (10 cases), and A1 portion of the anterior cerebral artery (5 cases).
  
  
  
  This study found evidence of centripetal propagation of vasoconstriction on MRA obtained at the time of thunderclap headache remission, compared with MRA obtained at the time of reversible cerebral vasoconstriction syndrome onset. If clinicians remain unsure of the diagnosis during early-stage reversible cerebral vasoconstriction syndrome, this time point represents the best opportunity to diagnose reversible cerebral vasoconstriction syndrome with confidence.
authors.affiliation: From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan mashimoda-nsu@umin.ac.jp.
authors.forename: M
authors.identifier: 0000-0001-5758-739X
authors.initials: M
authors.lastname: Shimoda
authors.affiliation: From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan.
authors.forename: S
authors.identifier: 0000-0001-9170-5732
authors.initials: S
authors.lastname: Oda
authors.affiliation: From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan.
authors.forename: A
authors.identifier: 0000-0003-1826-1914
authors.initials: A
authors.lastname: Hirayama
authors.affiliation: From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan.
authors.forename: M
authors.identifier: 0000-0001-5232-2181
authors.initials: M
authors.lastname: Imai
authors.affiliation: From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan.
authors.forename: F
authors.identifier: 0000-0002-4960-9402
authors.initials: F
authors.lastname: Komatsu
authors.affiliation: From the Department of Neurosurgery (M.S., S.O., A.H., M.I., F.K., K.H.), Tokai University Hachioji Hospital, Tokyo, Japan.
authors.forename: K
authors.identifier: 0000-0002-5982-5619
authors.initials: K
authors.lastname: Hoshikawa
authors.affiliation: Department of Neurosurgery (H.S., J.N., T.O.), Tokai University School of Medicine, Kanagawa, Japan.
authors.forename: H
authors.identifier: 0000-0003-2639-0601
authors.initials: H
authors.lastname: Shigematsu
authors.affiliation: Department of Neurosurgery (H.S., J.N., T.O.), Tokai University School of Medicine, Kanagawa, Japan.
authors.forename: J
authors.identifier: 0000-0002-0704-7827
authors.initials: J
authors.lastname: Nishiyama
authors.affiliation: Department of Neurosurgery (H.S., J.N., T.O.), Tokai University School of Medicine, Kanagawa, Japan.
authors.forename: T
authors.identifier: 0000-0003-0593-1093
authors.initials: T
authors.lastname: Osada
mesh_terms: D000328:Adult; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D051270:Headache Disorders, Primary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D013577:Syndrome; D014661:Vasoconstriction