Original Article

Transcranial color doppler study for reversible cerebral vasoconstriction syndromes

  1. Shih-Pin Chen MD1,2,3,
  2. Jong-Ling Fuh MD2,4,
  3. Feng-Chi Chang MD2,5,
  4. Jiing-Feng Lirng MD2,5,
  5. Ben-Chang Shia PhD6,
  6. Shuu-Jiun Wang MD2,4,*

Article first published online: 21 MAY 2008

DOI: 10.1002/ana.21384

Issue

Annals of Neurology

Annals of Neurology

Volume 63, Issue 6, pages 751–757, June 2008

Additional Information

How to Cite

Chen, S.-P., Fuh, J.-L., Chang, F.-C., Lirng, J.-F., Shia, B.-C. and Wang, S.-J. (2008), Transcranial color doppler study for reversible cerebral vasoconstriction syndromes. Annals of Neurology, 63: 751–757. doi: 10.1002/ana.21384

Author Information

  1. 1

    Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

  2. 2

    Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

  3. 3

    Department of Neurology, Taoyuan Veterans Hospital, Taoyuan, Taiwan

  4. 4

    The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

  5. 5

    Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

  6. 6

    Department of Statistics and Information Science, Fu-Jen Catholic University, Taipei, Taiwan

*Neurological Institute, Taipei Veterans General Hospital, No. 201, Shi-Pai Road, Section 2, Taipei, Taiwan, 112

Publication History

  1. Issue published online: 20 JUN 2008
  2. Article first published online: 21 MAY 2008
  3. Manuscript Accepted: 15 FEB 2008
  4. Manuscript Revised: 4 FEB 2008
  5. Manuscript Received: 20 NOV 2007

Funded by

  • Taipei-Veterans General Hospital. Grant Number: V96C1-041

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Abstract

Objective

Reversible cerebral vasoconstriction syndromes (RCVS) are characterized by thunderclap headaches and reversible cerebral vasoconstrictions. No systematic studies on cerebral hemodynamics have been published.

Methods

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 (VMCA) and Lindegaard Index (LI) were recorded and compared with those of controls.

Results

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 VMCA (109.5 ± 30.8cm/sec) and LI (2.2 ± 0.7) of RCVS patients exceeded those of controls (VMCA: 66.3 ± 9.5cm/sec, p < 0.001; LI: 1.4 ± 0.3, p < 0.001). The VMCA 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 VMCA 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 VMCA greater than 120cm/sec and LI greater than 3, had a greater risk of posterior leukoencephalopathy (75 vs 4%; p = 0.003) and ischemic strokes (50 vs 0%; p = 0.01) than those without.

Interpretation

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

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