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Repetitive use of intra-arterial verapamil in the treatment of reversible cerebral vasoconstriction syndrome |
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| Authors: | Kris F French Robert E HoeschJuliann Allred Michael WilderAG Smith Kathleen B DigreDonald V La Barge III |
| Institution: | a Department of Neurology and Clinical Neurosciences, Clinical Neurosciences Center, University of Utah Hospitals and Clinics, 175 N Medical Drive East, Salt Lake City 84132, UT, USA b Critical Care Neurosciences, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA c Neuro-Interventional Radiology, Department of Neuroradiology, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA d Neuromuscular Department, Department of Neurology and Clinical Neurosciences, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA e Department of Neuro-Ophthalmology, Moran Eye Center, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA f Department of Radiology, Division of Interventional Neuroradiology, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA |
| Abstract: | Reversible cerebral vasoconstriction syndrome (RCVS) typically presents with recurrent thunderclap headaches and neurological deficits that are usually self-limiting. The intra-arterial (IA) use of vasodilators for RCVS has been reported for severe cases. Patients with RCVS have the potential for serious and permanent neurological deficits. It is a rare disorder, with a recent surge in the number of reports, and probably continues to be under-diagnosed. We report two patients with RCVS with severe neurological sequelae, treated in a large tertiary hospital. Both patients received high-dose cortico steroids due to the possibility of angiitis of the central nervous system, but they deteriorated neurologically, which suggests that steroids may have a deleterious effect in RCVS. Treatment with IA verapamil resulted in reversal of vasoconstriction, but multiple treatments were necessary. Therefore, IA administration of verapamil is a possible treatment for severe RCVS, but there is only limited sustained improvement in vasodilation that may require repetitive treatments with a currently undetermined optimal treatment interval. |
| Keywords: | Intra-arterial vasodilator therapy Reversible cerebral vasoconstriction syndrome Thunderclap headache |
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