Conflict of Interest: Dr. Dou reports no disclosures. Dr. Chen received grants from Taipei Veterans General Hospital and National Science Councils, Taiwan. Dr. Jong-Ling Fuh is a member of a scientific advisory board of Elli Lilly and Novartis, and has as well received research support from the Taiwan National Science Council, Taipei-Veterans General Hospital, and Elli Lilly. Dr. Shuu-Jiun Wang has served on the advisory boards of Pfizer, Allergan, and Elli Lilly Taiwan. He has received speaking honoraria from local companies (Taiwan branches) of Pfizer, Elli Lilly, Boehringer Ingelheim, and GSK. He has received research grants from the Taiwan National Science Council, Taipei-Veterans General Hospital, and Taiwan Headache Society.
Reversible Cerebral Vasoconstriction Syndrome After Blood Transfusion
Article first published online: 13 MAR 2014
© 2014 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 54, Issue 4, pages 736–744, April 2014
How to Cite
Dou, Y.-H., Fuh, J.-L., Chen, S.-P. and Wang, S.-J. (2014), Reversible Cerebral Vasoconstriction Syndrome After Blood Transfusion. Headache: The Journal of Head and Face Pain, 54: 736–744. doi: 10.1111/head.12319
- Issue published online: 2 APR 2014
- Article first published online: 13 MAR 2014
- Manuscript Accepted: 27 DEC 2013
- National Science Council of Taiwan. Grant Numbers: 100-2314-B-010-019-MY2, 100-2314-B-010-018-MY3
- Taipei-Veterans General Hospital. Grant Numbers: VGHUST102-G7-6-1, V102C-118, V102E9-001
- NSC support for Center for Dynamical Biomarkers and Translational Medicine, National Central University. Grant Number: NSC 101-2911-I-008-001
- Brain Research Center, National Yang-Ming University
- Ministry of Education, Aim for the Top University Plan
- reversible cerebral vasoconstriction syndrome;
- blood transfusion;
- posterior reversible encephalopathy syndrome;
- chronic anemia
To report 2 cases of reversible cerebral vasoconstriction syndrome (RCVS) with posterior reversible encephalopathy syndrome (PRES) after blood transfusion for severe anemia.
RCVS is presented with recurrent thunderclap headache and reversible constriction of cerebral arteries. PRES is a known complication of RCVS. Blood transfusion for severe anemia could be a cause for PRES in few cases; however, it is seldom mentioned as an etiology for RCVS.
We report a case series.
We report 2 women presented with RCVS with PRES after blood transfusion for anemia, and reviewed another 4 similar cases reported in the literature. Our 2 patients were middle-aged women, with severe chronic anemia (average hemoglobin: 1.45 g/dL), and received multiple blood transfusions (average: 3250 mL) over a period of 5-7 days. They developed thunderclap headache and other symptoms about 1 week after the last blood transfusion. Cerebral vasoconstrictions were demonstrated by magnetic resonance angiography and transcranial color-coded sonography. PRES was found in both of them using magnetic resonance imaging, and one of them also had cytotoxic edema on diffusion weighted image.
RCVS with PRES is one complication of blood transfusion in patients under chronic severe anemia (especially when hemoglobin level increased for more than 5 g/dL), particularly in Asian women with menorrhagia. Blood pressure surge and the occurrence of severe headaches or other neurological symptoms should be aggressively monitored within 10 days after the last blood transfusion.