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. 2022 Jan;29(1):130-137.
doi: 10.1111/ene.15064. Epub 2021 Aug 24.

Type of headache at onset and risk for complications in reversible cerebral vasoconstriction syndrome

Kristin Sophie Lange  1   2   3 , Ophélie Forster  1 , Jérôme Mawet  4 , Gabrielle Tuloup  5 , Cécilia Burcin  4 , Lucas Corti  1 , Claire Duflos  6 , Caroline Roos  4 , Anne Ducros  1   7
Affiliations

Type of headache at onset and risk for complications in reversible cerebral vasoconstriction syndrome

Kristin Sophie Lange et al. Eur J Neurol. 2022 Jan.

Abstract

Background: In a recent Italian study, 30% of patients with reversible cerebral vasoconstriction syndrome (RCVS) presented without thunderclap headache (TCH), and tended to present more severe forms of RCVS than patients with TCH. We aimed to analyze the risk for complications of RCVS in patients with and without TCH at onset.

Methods: In a pooled cohort of 345 French patients with RCVS, we compared patients with and without TCH at onset regarding rates of neurological complications, and the functional outcome at 3 months.

Results: As compared to the 281 patients with TCH at onset, the 64 patients without TCH had a higher risk for any neurological complication (61% vs. 24%, OR 4.9, 95% CI 2.8-8.7, p < 0.001). The association was strongest for cervical artery dissections (28% vs. 5%, OR 8.1, 95% CI 3.7-17.6, p < 0.001), followed by posterior reversible encephalopathy syndrome (17% vs. 3%, OR 7.1, 95% CI 2.7-18.4, p < 0.001), seizures (9% vs. 2.5%, OR 4.1, 95% CI 1.3-12.5, p = 0.019), and subarachnoid hemorrhage (41% vs. 16%, OR 3.5, 95% CI 1.9-6.3, p < 0.001). In multivariable analysis, the risk for any neurological complication remained significantly elevated in the absence of TCH (OR 3.5, 95% CI 1.8-6.8, p < 0.001). The functional outcome was equal in both groups, with a modified Rankin scale score of 0-1 in ≥90% of patients.

Conclusions: Absence of TCH at onset might predict a higher risk of complications in RCVS. Our results warrant further multicentric studies to prove this finding.

Keywords: calcitonin gene-related peptide; cerebrovascular diseases; reversible cerebral vasoconstriction syndrome; stroke; thunderclap headache.

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References

REFERENCES

    1. Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol. 2012;11(10):906-917. doi:10.1016/S1474-4422(12)70135-7
    1. Chen SP, Fuh JL, Lirng JL, Wang YF, Wang SJ. Recurrence of reversible cerebral vasoconstriction syndrome. A long-term follow-up study. Neurology. 2015;84(15):1552-1558. doi:10.1212/WNL.0000000000001473
    1. Caria F, Zedde M, Gamba M, et al. The clinical spectrum of reversible cerebral vasoconstriction syndrome: the Italian Project on Stroke at Young Age (IPSYS). Cephalalgia. 2019;39(10):1267-1276. doi:10.1177/0333102419849013
    1. Boitet R, de Gaalon S, Duflos C, et al. Long- term outcomes after reversible cerebral vasoconstriction syndrome. Stroke. 2020;51(2):670-673. doi:10.1161/STROKEAHA.119.027703
    1. John S, Singhal AB, Calabrese L, et al. Long-term outcomes after reversible cerebral vasoconstriction syndrome. Cephalalgia. 2015;36(4):387-394. doi:10.1177/0333102415591507

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