title: Cerebral vasomotor reactivity in reversible cerebral vasoconstriction syndrome.
abstract: Background Altered cerebrovascular tone is implicated in reversible cerebral vasoconstriction syndrome (RCVS). We evaluated vasomotor reactivity using bedside transcranial Doppler in RCVS patients. Methods In this retrospective case-control study, middle cerebral artery (MCA) blood flow velocities were compared at rest and in response to breath-hold in RCVS ( n = 8), Migraineurs ( n = 10), and non-headache Controls ( n = 10). Hyperventilation response was measured in RCVS. Results In RCVS, Breath Holding Index (BHI) was severely reduced in seven of eight patients and 14/16 MCAs; seven of 16 MCAs showed exhausted (BHI < 0.1) or inverted (BHI < 0) vasomotor reactivity. Mean BHI in RCVS (0.23 ± 0.5) was significantly lower than Migraine (1.52 ± 0.57) and Controls (1.51 ± 0.32), p < 0.001. Triphasic velocity responses were seen in all groups. The maximum Vmeandecline during the middle negative phase was -15.5 ± 9.2% in RCVS, -15.4 ± 7% in Migraine, and -10.3 ± 5% in Controls ( p = 0.04). In the late positive phase, average Vmeanincrease was 6.2 ± 14% in RCVS, which was significantly lower ( p < 0.001) than Migraine (30.5 ± 11%) and Controls (30.2 ± 6%). With hyperventilation, RCVS patients showed 23% decrease in Vmean. Conclusion Cerebral arterial tone is abnormal in RCVS, with proximal vasoconstriction and abnormally reduced capacity for vasodilation. Further studies are needed to determine the utility of BHI to diagnose RCVS before angiographic reversibility is established, and to estimate prognosis.
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.|2 Department of Neurology, Hacettepe University Hospitals, Ankara, Turkey.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Topcuoglu
authors.affiliation: 3 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
authors.forename: Suk-Tak
authors.initials: ST
authors.lastname: Chan
authors.affiliation: 4 Department of Neurology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Gisele Sampaio
authors.initials: GS
authors.lastname: Silva
authors.affiliation: 5 Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: Eric Edward
authors.initials: EE
authors.lastname: Smith
authors.affiliation: 3 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Kwong
authors.affiliation: 1 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Aneesh Bhim
authors.initials: AB
authors.lastname: Singhal
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods; D014661:Vasoconstriction / Q000502:physiology; D014666:Vasomotor System / Q000503:physiopathology*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055815:Young Adult
keywords: Reversible cerebral vasoconstriction syndrome; breath-hold challenge; cerebrovascular reactivity; migraine; transcranial Doppler