Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Sep;56(9):2516-2526.
doi: 10.1161/STROKEAHA.125.051733. Epub 2025 Jun 26.

Regional Differences in Presentation, Cause, and Outcome of Reversible Cerebral Vasoconstriction Syndrome

Kristin Sophie Lange  1   2   3 , Shuu-Jiun Wang  4   5   6 , Alessandro Pezzini  7   8 , Giulia Avola  7 , So Youn Choi  9 , Yu-Hsiang Ling  4   5 , Yen-Feng Wang  4   5 , Jong-Ling Fuh  4   5 , Jérôme Mawet  10 , Caroline Roos  10 , Gabrielle Tuloup  10 , Claire Duflos  11 , Shih-Pin Chen  4   12   5   6   13 , Mi Ji Lee  9 , Anne Ducros  3   14 ; REVERCE Investigators
Collaborators, Affiliations
Observational Study

Regional Differences in Presentation, Cause, and Outcome of Reversible Cerebral Vasoconstriction Syndrome

Kristin Sophie Lange et al. Stroke. 2025 Sep.

Abstract

Background: National studies on reversible cerebral vasoconstriction syndrome (RCVS) point to differences between Asian and European patients. We investigated geographic variations in neurological complications, outcomes, and causes.

Methods: We conducted an exploratory analysis of pooled individual patient data from the Reversible Cerebral Vasoconstriction Syndrome International Collaborative network, a multicenter observational cohort study including patients with definite RCVS from 2 French, 32 Italian, 1 South Korean, and 1 Taiwanese centers. Data on demographics, precipitants, symptoms, imaging, treatment, and outcomes were collected. The primary end point was RCVS-associated brain lesions, including ischemic stroke, cortical subarachnoid hemorrhage, intracerebral hemorrhage, posterior reversible encephalopathy syndrome, and subdural hematoma. Secondary end points included unfavorable 3-month outcomes (modified Rankin Scale score ≥1) and causes (idiopathic versus secondary). Odds ratios and 95% CIs were calculated using multivariable logistic regression, adjusting for potential confounders.

Results: From 2009 to 2021, we included 1127 patients (528 European and 599 Asian). Recruitment occurred either through emergency settings or outpatient clinics, with most Asian patients recruited from outpatient clinics (65.8%) and most European patients from emergency settings (99.8%). Brain lesions were more frequent in European patients (29.2% versus 6.3%; odds ratio, 4.09 [95% CI, 2.66-6.30]). In a sensitivity analysis restricted to hospitalized patients (n=651), the association persisted. Unfavorable 3-month outcomes (5.5% versus 1.7%; odds ratio, 3.01 [95% CI, 1.35-6.68]) and secondary RCVS (50.4% versus 10.9%; odds ratio, 7.09 [95% CI, 5.14-9.76]) were also associated with European residency.

Conclusions: RCVS presentations vary across regions, with higher lesion rates, more secondary forms, and worse outcomes in European patients. While these exploratory results may reflect selection bias from differing health care structures, further research is needed to determine the contribution of genetic, environmental, and societal factors.

Keywords: cerebral arterial diseases; headache; intracranial hemorrhages; stroke; vasoconstriction.

PubMed Disclaimer

Conflict of interest statement

The authors do not have any conflicts of interest related to the submitted work. Dr Lange reports a research grant from the International Headache Society and personal fees from Teva and Organon. Dr Wang receives personal fees from AbbVie, Pfizer, Eli Lilly Taiwan Branch, Biogen, and Percept Co; research grants from Eli Lilly Taiwan branch, Novartis, and Orient Europharma; and has been a principal investigator in trials sponsored by AbbVie, Novartis, Lundbeck, Orient Europharma, and Pfizer. Dr Mawet reports personal fees from Abbvie, Teva, Lilly, Lundbeck, Pfizer, Dr Reddys’s Laboratories, Ipsen, and Orion Pharmaceuticals. Dr Roos reports personal fees for being an advisor, a speaker, and a consultant for Abbvie, Lundbeck, Lilly, Sanofi, Orkyn, and Pfizer and travel, accommodation, and meeting expenses from Abbvie, Lundbeck, and SOS Oxygene. Dr Lee reports personal fees from Eli Lilly, Lundbeck, Pfizer, Samjin Pharm, NuEyne, Teva, Abbvie, SK, DongA, CKD Pharm, YuYu Pharma, and Ildong Pharm and research grants or contracts from Otsuka, Novartis, Abbvie, Biohaven, Lundbeck, Ildong Pharm, and Pfizer. Dr Ducros reports personal fees from Abbvie, Lilly, Lundbeck, Novartis, Pfizer, SOS Oxygene, and Teva and research grants from Pfizer. The other authors report no conflicts.

Publication types

LinkOut - more resources