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Reversible Cerebral Vasoconstriction Syndrome in Patients with Coronavirus Disease: A Multicenter Case Series.
Arandela, Kristine; Samudrala, Shilpa; Abdalkader, Mohamad; Anand, Pria; Daneshmand, Ali; Dasenbrock, Hormuzdiyar; Nguyen, Thanh; Ong, Charlene; Takahashi, Courtney; Shulman, Julie; Babi, Marc Alain; Sivakumar, Sanjeev; Shah, Neel; Jain, Sandip; Anand, Samyuktha; Nobleza, Christa O'Hana S; Shekhar, Shashank; Venkatasubramanian, Chitra; Salahuddin, Hisham; Taqi, Muhammad A; Nour, Hassan Aboul; Nofar, Justin B; Cervantes-Arslanian, Anna M.
  • Arandela K; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States.
  • Samudrala S; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States.
  • Abdalkader M; Departments of Radiology, Boston University School of Medicine and Boston Medical Center, United States.
  • Anand P; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States.
  • Daneshmand A; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States; Departments of Neurosurgery, Boston University School of Medicine and Boston Medical Center, United States.
  • Dasenbrock H; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States; Departments of Neurosurgery, Boston University School of Medicine and Boston Medical Center, United States.
  • Nguyen T; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States; Departments of Radiology, Boston University School of Medicine and Boston Medical Center, United States.
  • Ong C; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States; Departments of Neurosurgery, Boston University School of Medicine and Boston Medical Center, United States.
  • Takahashi C; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States; Departments of Neurosurgery, Boston University School of Medicine and Boston Medical Center, United States.
  • Shulman J; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States.
  • Babi MA; Departments of Neurology and Neurosurgery, University of Florida, United States.
  • Sivakumar S; Department of Neurology, University of South Carolina Greenville School of Medicine, United States.
  • Shah N; Department of Neurology, University of South Carolina Greenville School of Medicine, United States.
  • Jain S; Department of Neurology, University of South Carolina Greenville School of Medicine, United States.
  • Anand S; Department of Neurology, Prisma Health-Upstate, United States.
  • Nobleza COS; Departments Neurology and Neurosurgery, University of Mississippi Medical Center, United States.
  • Shekhar S; Departments Neurology and Neurosurgery, University of Mississippi Medical Center, United States.
  • Venkatasubramanian C; Department of Neurology, Stanford University, United States.
  • Salahuddin H; Department of Neurology, Antelope Valley Hospital, United States.
  • Taqi MA; Department of Neurology, Los Robles Medical Center, United States.
  • Nour HA; Department of Neurology, Henry Ford Health System, United States.
  • Nofar JB; Department of Neurology, Henry Ford Health System, United States.
  • Cervantes-Arslanian AM; Departments of Neurology, Boston University School of Medicine and Boston Medical Center, United States; Departments of Neurosurgery, Boston University School of Medicine and Boston Medical Center, United States; Departments of Medicine Infectious Diseases, Boston University School of Medicine and B
J Stroke Cerebrovasc Dis ; 30(12): 106118, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1415616
ABSTRACT
BACKGROUND AND

OBJECTIVES:

RCVS (Reversible Cerebral Vasoconstrictive Syndrome) is a condition associated with vasoactive agents that alter endothelial function. There is growing evidence that endothelial inflammation contributes to cerebrovascular disease in patients with coronavirus disease 2019 (COVID-19). In our study, we describe the clinical features, risk factors, and outcomes of RCVS in a multicenter case series of patients with COVID-19. MATERIALS AND

METHODS:

Multicenter retrospective case series. We collected clinical characteristics, imaging, and outcomes of patients with RCVS and COVID-19 identified at each participating site.

RESULTS:

Ten patients were identified, 7 women, ages 21 - 62 years. Risk factors included use of vasoconstrictive agents in 7 and history of migraine in 2. Presenting symptoms included thunderclap headache in 5 patients with recurrent headaches in 4. Eight were hypertensive on arrival to the hospital. Symptoms of COVID-19 included fever in 2, respiratory symptoms in 8, and gastrointestinal symptoms in 1. One patient did not have systemic COVID-19 symptoms. MRI showed subarachnoid hemorrhage in 3 cases, intraparenchymal hemorrhage in 2, acute ischemic stroke in 4, FLAIR hyperintensities in 2, and no abnormalities in 1 case. Neurovascular imaging showed focal segment irregularity and narrowing concerning for vasospasm of the left MCA in 4 cases and diffuse, multifocal narrowing of the intracranial vasculature in 6 cases. Outcomes varied, with 2 deaths, 2 remaining in the ICU, and 6 surviving to discharge with modified Rankin scale (mRS) scores of 0 (n=3), 2 (n=2), and 3 (n=1).

CONCLUSIONS:

Our series suggests that patients with COVID-19 may be at risk for RCVS, particularly in the setting of additional risk factors such as exposure to vasoactive agents. There was variability in the symptoms and severity of COVID-19, clinical characteristics, abnormalities on imaging, and mRS scores. However, a larger study is needed to validate a causal relationship between RCVS and COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Vasoconstriction / Cerebral Arteries / Cerebrovascular Circulation / Vasospasm, Intracranial / COVID-19 Subject: Vasoconstriction / Cerebral Arteries / Cerebrovascular Circulation / Vasospasm, Intracranial / COVID-19 Type of study: Controlled clinical trial / Diagnostic study / Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: J Stroke Cerebrovasc Dis Clinical aspect: Etiology Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Vasoconstriction / Cerebral Arteries / Cerebrovascular Circulation / Vasospasm, Intracranial / COVID-19 Subject: Vasoconstriction / Cerebral Arteries / Cerebrovascular Circulation / Vasospasm, Intracranial / COVID-19 Type of study: Controlled clinical trial / Diagnostic study / Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: J Stroke Cerebrovasc Dis Clinical aspect: Etiology Year: 2021
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