title: Cerebral endothelial dysfunction in reversible cerebral vasoconstriction syndrome: a case-control study.
abstract: BACKGROUND
  The aim of this study is to investigate cerebral endothelial dysfunction in patients with reversible cerebral vasoconstriction syndrome (RCVS).
  
  
  METHODS
  We prospectively recruited patients with RCVS, age-matched controls with episodic migraine, and age-matched healthy controls at Samsung Medical Center from Apr 2015 to Jul 2016. All participants underwent transcranial Doppler evaluation, with a breath-holding maneuver, for the evaluation of bilateral middle cerebral arteries (MCAs), posterior cerebral arteries (PCAs), and the basilar artery (BA). The breath-holding index (BHI) was used to measure cerebral endothelium-dependent vasodilation. Follow-up BHIs were recorded in selected patients with RCVS after 3 months.
  
  
  RESULTS
  A total of 84 subjects were recruited for this study (n = 28 in each group of RCVS, episodic migraine, and healthy control; mean age, 49.8 years). The RCVS group showed lower BHIs in all basal arteries, in comparison to healthy controls (p < 0.001, 0.009 for bilateral MCAs, p < 0.001 and 0.028 for bilateral PCAs, and p = 0.060 for the BA). Compared to migraineurs, RCVS patients had lower BHIs only in the anterior circulation (p = 0.002 and 0.038 for bilateral MCAs; p = 0.069 and 0.247 for bilateral PCAs; p = 0.120 for the BA). Of the 10 patients who had follow-up BHIs at 3 months, 7 showed complete normalization, while three did not.
  
  
  CONCLUSIONS
  Cerebral endothelial function is impaired in a widespread distribution in RCVS. Its role in the pathogenesis and clinical outcome of RCVS should be determined in further studies.
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Neurology, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06531, South Korea.
authors.forename: Hyun Ah
authors.initials: HA
authors.lastname: Choi
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Neurology, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06531, South Korea.
authors.forename: Mi Ji
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Neurology, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06531, South Korea. cspaul@naver.com.
authors.forename: Chin-Sang
authors.initials: CS
authors.lastname: Chung
mesh_terms: D000328:Adult; D062485:Breath Holding; D016022:Case-Control Studies; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011446:Prospective Studies; D013577:Syndrome; D017585:Ultrasonography, Doppler, Transcranial; D014661:Vasoconstriction / Q000502:physiology*
keywords: Breath holding index; Cerebral vasomotor reactivity; Endothelial dysfunction; Pathophysiology; Reversible cerebral vasoconstriction syndrome