Transcranial Doppler findings in reversible cerebral vasoconstriction syndrome

Mausaminben Hathidara, Nidhi H. Patel, Alan Flores, Yosdely Cabrera, Frank Cabrera, Sebastian Koch

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose: Reversible cerebral vasoconstriction syndrome (RCVS) is a syndrome characterized by reversible segmental vasoconstriction of cerebral arteries. Digital subtraction and noninvasive angiograms are typically used to detect vasospasm; however, due to the dynamic nature of RCVS these tests are often negative initially and may need to be repeated multiple times. Transcranial Doppler (TCD) offers many advantages as it is a noninvasive and nonradiating modality. Studies investigating its diagnostic utility for capturing vasospasm and studying temporal evolution of RCVS are limited. Methods: We conducted a retrospective analysis on all patients admitted with suspected RCVS from 2009 to 2014 to a single center at Jackson Memorial Hospital. Results: We identified 9 patients (88.9% women, age 46.6 ± 13.5 years) who met diagnostic criteria for RCVS. All patients presented with headache, 5 developed nonaneurysmal subarachnoid hemorrhage, 5 developed ischemic stroke, and 1 developed posterior reversible encephalopathy syndrome. At initial TCD, 8 patients had increased flow velocities in at least one large intracranial artery and ultimately all patients had abnormal middle cerebral artery flow velocity over the course of RCVS. We found that the number of vessels with abnormal velocities increases gradually and peaks between 13 and 14 days after first symptom onset. Finally, mean flow velocity of affected vessels also increases around the same time frame and normalizes at 60 days. Conclusions: In this case series, we found TCD to be useful in detecting vasospasm and monitoring the temporal evolution of RCVS. TCD could be a helpful clinical tool to diagnose and monitor RCVS.

Original languageEnglish (US)
Pages (from-to)345-351
Number of pages7
JournalJournal of Neuroimaging
Volume32
Issue number2
DOIs
StatePublished - Mar 1 2022

Keywords

  • cerebrovascular
  • reversible cerebral vasoconstriction syndrome
  • transcranial Doppler
  • vasospasm

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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