Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome
- 17 January 2017
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 88 (3), 228-236
- https://doi.org/10.1212/wnl.0000000000003510
Abstract
Objective: Factors predicting poor outcome in patients with the reversible cerebral vasoconstriction syndrome (RCVS) have not been identified. Methods: In this single-center retrospective study, we analyzed the clinical, brain imaging, and angiography data in 162 patients with RCVS. Univariable and multivariable regression analysis were performed to identify predictors of persistent (nontransient) clinical worsening, radiologic worsening, early angiographic progression, and poor discharge outcome (modified Rankin Scale score 4–6). Results: The mean age was 44 ± 13 years; 78% of patients were women. Persistent clinical worsening occurred in 14% at 6.6 ± 4.1 days after symptom onset, radiologic worsening in 27% (mainly new infarcts), and angiographic progression in 15%. Clinical worsening correlated with angiographic progression and new nonhemorrhagic lesions. Age and sex did not independently predict any type of worsening. Infarction on baseline imaging predicted poor outcome. Prior serotonergic antidepressant use predicted clinical and angiographic worsening but not poor outcome. Intra-arterial vasodilator therapy independently predicted clinical worsening and poor discharge outcome but was offered to more severe cases. Glucocorticoid treatment proved to be an independent predictor of clinical, imaging, and angiographic worsening and poor outcome. Of the 23 patients with clinical worsening, 17 received glucocorticoids (15 within the preceding 2 days). There were no significant differences in baseline brain lesions and angiographic abnormalities between glucocorticoid-treated and untreated patients. Conclusion: Patients with RCVS at risk for worsening can be identified on basis of baseline features. Iatrogenic factors such as glucocorticoid exposure may contribute to worsening.Keywords
This publication has 31 references indexed in Scilit:
- Hemorrhagic Reversible Cerebral Vasoconstriction SyndromeStroke, 2016
- Long-term outcomes after reversible cerebral vasoconstriction syndromeCephalalgia, 2015
- A Novel Approach to Diagnose Reversible Cerebral Vasoconstriction Syndrome: A Case SeriesJournal Of Stroke & Cerebrovascular Diseases, 2015
- Reversible Cerebral Vasoconstriction Syndromes: What the Cardiologist Should KnowCurrent Treatment Options in Cardiovascular Medicine, 2014
- Reversible Cerebral Vasoconstriction Syndrome: A Complicated Clinical Course Treated with Intra-Arterial Application of NimodipineCephalalgia, 2009
- The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patientsBrain, 2007
- Narrative Review: Reversible Cerebral Vasoconstriction SyndromesAnnals of Internal Medicine, 2007
- Reversible cerebral angiopathyZeitschrift für Neurologie, 2006
- The role of corticosteroids in the regulation of vascular toneCardiovascular Research, 1999
- Benign angiopathy: a distinct subset of angiographically defined primary angiitis of the central nervous system.1993