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Reversible Cerebral Vasoconstriction Syndrome After Blood Transfusion

Authors

  • Yi-Hsuan Dou MD,

    1. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Jong-Ling Fuh MD,

    1. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    3. Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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  • Shih-Pin Chen MD, PhD,

    1. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    3. Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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  • Shuu-Jiun Wang MD

    Corresponding author
    1. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    3. Brain Research Center, National Yang-Ming University, Taipei, Taiwan
    4. Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
    • Address all correspondence to S.-J. Wang, Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei 11217, Taiwan.

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  • 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.

Abstract

Objectives

To report 2 cases of reversible cerebral vasoconstriction syndrome (RCVS) with posterior reversible encephalopathy syndrome (PRES) after blood transfusion for severe anemia.

Background

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.

Methods

We report a case series.

Results

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.

Conclusions

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.

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