Steroid-Responsive Reversible Cerebral Vasoconstriction Syndrome

A 50-year-old woman with thunderclap headache and transient neurologic symptoms was diagnosed with reversible cerebral vasoconstriction syndrome. Serial angiography showed multifocal arterial vasoconstrictions, and MRI revealed multiple scattered cerebral infarctions. New neurologic symptoms and vasoconstriction in other arteries occurred repeatedly despite the on-going administration of traditional treatments. However, the symptoms reduced dramatically after administering intravenous steroid pulse therapy. This case suggests that steroid therapy can be considered as an alternative treatment when reversible cerebral vasoconstriction syndrome is intractable to traditional treatment.

Cerebral Arterial Calcification Is an Imaging Prognostic Marker for Revascularization Treatment of Acute Middle Cerebral Arterial Occlusion / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: To study the significance of intracranial artery calcification as a prognostic marker for acute ischemic stroke patients undergoing revascularization treatment after middle cerebral artery (MCA) trunk occlusion. METHODS: Patients with acute MCA trunk occlusion, who underwent intravenous and/or intra-arterial revascularization treatment, were enrolled. Intracranial artery calcification scores were calculated by counting calcified intracranial arteries among major seven arteries on computed tomographic angiography. Patients were divided into high (HCB; score > or =3) or low calcification burden (LCB; score <3) groups. Demographic, imaging, and outcome data were compared, and whether HCB is a prognostic factor was evaluated. Grave prognosis was defined as modified Rankin Scale 5-6 for this study. RESULTS: Of 80 enrolled patients, the HCB group comprised 15 patients, who were older, and more commonly had diabetes than patients in the LCB group. Initial National Institutes of Health Stroke Scale (NIHSS) scores did not differ (HCB 13.3+/-2.7 vs. LCB 14.6+/-3.8) between groups. The final good reperfusion after revascularization treatment (thrombolysis in cerebral infarction score 2b-3, HCB 66.7% vs. LCB 69.2%) was similarly achieved in both groups. However, the HCB group had significantly higher NIHSS scores at discharge (16.0+/-12.3 vs. 7.9+/-8.3), and more frequent grave outcome at 3 months (57.1% vs. 22.0%) than the LCB group. HCB was proven as an independent predictor for grave outcome at 3 months when several confounding factors were adjusted (odds ratio 4.135, 95% confidence interval, 1.045-16.359, P=0.043). CONCLUSIONS: Intracranial HCB was associated with grave prognosis in patients who have undergone revascularization for acute MCA trunk occlusion.

Posterior Reversible Encephalopathy Syndrome Following Bee Venom Acupuncture

A 64-year-old woman presented with headache and visual disturbance which occurred 10 minutes after bee venom acupuncture. She was normotensive. Her pupils were isocoric and normally reflexive but she could precept only lights just in front of her eyes. The brain MRI showed vasogenic edema in the cerebellum and occipitotemporoparietal areas. She fully recovered 2 days later. The brain MRI taken after 7 days revealed remarkable improvement. This case suggests that bee venom might cause posterior reversible encephalopathy syndrome.