Transcranial color doppler study for reversible cerebral vasoconstriction syndromes

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>Reversible cerebral vasoconstriction syndromes (RCVS) are characterized by thunderclap headaches and reversible cerebral vasoconstrictions. No systematic studies on cerebral hemodynamics have been published.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients with RCVS were consecutively recruited. Sequential transcranial color‐coded sonography studies were performed on the middle cerebral artery (MCA) for 3 months. Mean flow velocities (V<jats:sub>MCA</jats:sub>) and Lindegaard Index (LI) were recorded and compared with those of controls.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Thirty‐two patients (all female; average age, 49.7 ± 6.8 years) were enrolled. Four developed of reversible posterior leukoencephalopathy syndrome, and two of them, ischemic strokes. One hundred and twenty‐six sonography studies were performed on 57 eligible MCAs. The mean maximum V<jats:sub>MCA</jats:sub> (109.5 ± 30.8cm/sec) and LI (2.2 ± 0.7) of RCVS patients exceeded those of controls (V<jats:sub>MCA</jats:sub>: 66.3 ± 9.5cm/sec, <jats:italic>p</jats:italic> < 0.001; LI: 1.4 ± 0.3, <jats:italic>p</jats:italic> < 0.001). The V<jats:sub>MCA</jats:sub> and LI levels were still at their plateau at the mean time (day 22 after headache onset) of headache resolution. Fifteen (46.9%) patients had V<jats:sub>MCA</jats:sub> exceeding 120cm/sec, and 5 (16%) had LI exceeding 3. Patients fulfilling the criteria of subarachnoid hemorrhage mild vasospasm (n = 4; 13%), that is, both V<jats:sub>MCA</jats:sub> greater than 120cm/sec and LI greater than 3, had a greater risk of posterior leukoencephalopathy (75 vs 4%; <jats:italic>p</jats:italic> = 0.003) and ischemic strokes (50 vs 0%; <jats:italic>p</jats:italic> = 0.01) than those without.</jats:p></jats:sec><jats:sec><jats:title>Interpretation</jats:title><jats:p>Patients with RCVS experienced prolonged vasoconstriction, making the risk for posterior leukoencephalopathy and ischemic strokes outlast headache resolution. Patients fulfilling mild vasospasm criteria for subarachnoid hemorrhage carry a high risk. Ann Neurol 2008</jats:p></jats:sec>