title: Transcranial Doppler Ultrasonography As a Non-Invasive Tool for Diagnosis and Monitoring of Reversible Cerebral Vasoconstriction Syndrome.
abstract: OBJECTIVE
  Reversible cerebral vasoconstriction syndrome (RCVS) is a vascular headache disorder characterized by severe headaches with vasospasm of cerebral arteries. Transcranial Doppler ultrasonography (TCD) has been widely applied and validated in studying vasospasm of intracranial vessels, but the role of TCD in the diagnosis and monitoring of RCVS is less well established. We sought to determine the reliability of TCD for diagnosis and monitoring of RCVS.
  
  
  METHODS
  Patients admitted to an inpatient neurology service between 2011 and 2014 with a discharge diagnosis of RCVS were retrospectively analyzed for demographics, neuroimaging, and functional outcomes. Baseline and follow-up TCD flow velocities in the middle cerebral artery (Vmca) were compared relative to the final diagnosis.
  
  
  RESULTS
  The cohort consisted of fifteen patients (93% females; mean age 46.7 +/- 12.4 years); initial TCD evaluation was performed 10.9 +/- 6.6 (range 1-24) days after headache onset. Fourteen patients (93.3%) had increased flow velocities by initial TCD in at least one major cerebral blood vessel (MCA, ACA, PCA, vertebral, basilar). TCD flow velocities in the middle cerebral artery (Vmca) reached a mean peak of 163 cm/s three to four weeks after the onset of thunderclap headache.
  
  
  CONCLUSIONS
  TCD is a non-invasive neuroimaging modality that may have potential for the initial diagnosis and subsequent monitoring of patients with suspected RCVS. Larger studies will be needed to establish its utility. [Full article available at http://rimed.org/rimedicaljournal-2016-09.asp, free with no login].
authors: Neurophysiology Fellow, Rhode Island Hospital; Instructor in Neurology, The Warren Alpert Medical School of Brown University.
authors: Jay H
authors: JH
authors: Levin
authors: Cerebrovascular Laboratory, Rhode Island Hospital, Providence, RI.
authors: Jorge
authors: J
authors: Benavides
authors: Cerebrovascular Laboratory, Rhode Island Hospital, Providence, RI.
authors: Claudine
authors: C
authors: Caddick
authors: Cerebrovascular Laboratory, Rhode Island Hospital, Providence, RI.
authors: Kathleen
authors: K
authors: Laurie
authors: Department of Neurology, Alpert Medical School of Brown University; Cerebrovascular Laboratory, Rhode Island Hospital, Providence, RI.
authors: Janet
authors: J
authors: Wilterdink
authors: Department of Neurology, Alpert Medical School of Brown University, Providence, RI.
authors: Shadi
authors: S
authors: Yaghi
authors: Department of Neurology, Alpert Medical School of Brown University; Cerebrovascular Laboratory, Rhode Island Hospital, Providence, RI.
authors: Brian
authors: B
authors: Silver
authors: Department of Neurology, Alpert Medical School of Brown University; Cerebrovascular Laboratory, Rhode Island Hospital, Providence, RI; Neuroscience Institute (Division of Neurology), Spectrum Health, Michigan State University.
authors: Muhib
authors: M
authors: Khan
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply*; D005260:Female; D051270:Headache Disorders, Primary / Q000000981:diagnostic imaging*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging*
keywords: RCVS; Reversible Cerebral Vasoconstriction Syndrome; TCD; imaging; intracerebral hemorrhage; stroke; transcranial ultrasound