Reversible cerebral vasoconstriction syndrome successfully treated by intrathecal nicardipine
Reversible cerebral vasoconstriction syndrome (RCVS) presents with a thunderclap headache, often prompting brain imaging. Most patients fully recover with supportive care and time, but oral calcium channel blockers are often used in patients with severe vasoconstriction. In this case report, we pres...
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| Veröffentlicht in: | Clinical neurology and neurosurgery 2021-07, Vol.206, p.106705-106705, Article 106705 |
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| creator | Zeitouni, Daniel Parish, Jonathan M. Smith, Margaret Stetler, William R. Bernard, Joe D. |
| description | Reversible cerebral vasoconstriction syndrome (RCVS) presents with a thunderclap headache, often prompting brain imaging. Most patients fully recover with supportive care and time, but oral calcium channel blockers are often used in patients with severe vasoconstriction. In this case report, we present a patient with severe vasoconstriction leading to weakness refractory to oral calcium channel blockers. Intrathecal nicardipine was administered via an external ventricular drain and the patient subsequently showed improvement of her weakness and significant improvement of vasospasm on Computed Tomography Angiography. We suggest further studies to determine the efficacy of intrathecal nicardipine in patients with RCVS not responsive to oral calcium channel blockers.
•Reversible cerebral vasoconstriction syndrome (RCVS) is an under-diagnosed cause of severe headache.•Oral calcium channel blockers can be used for severe cases.•Intrathecal calcium channel blockers via EVD have been used to treat aneurysmal vasospasm.•Intrathecal nicardipine may be a treatment option for cases of refractory RCVS with neurologic deficit. |
| doi_str_mv | 10.1016/j.clineuro.2021.106705 |
| format | Article |
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•Reversible cerebral vasoconstriction syndrome (RCVS) is an under-diagnosed cause of severe headache.•Oral calcium channel blockers can be used for severe cases.•Intrathecal calcium channel blockers via EVD have been used to treat aneurysmal vasospasm.•Intrathecal nicardipine may be a treatment option for cases of refractory RCVS with neurologic deficit.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2021.106705</identifier><identifier>PMID: 34053805</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Angiography ; Angioplasty ; Blood pressure ; Calcium ; Computed tomography ; Female ; Headache ; Headache Disorders, Primary - etiology ; Headaches ; Hemorrhage ; Humans ; Infections ; Injections, Spinal ; Neuroimaging ; Neurology ; Nicardipine - administration & dosage ; Pathophysiology ; Patients ; Reversible Cerebral Vasoconstriction Syndrome ; Syndrome ; Vasoconstriction ; Vasodilator Agents - administration & dosage ; Vasospasm ; Vasospasm, Intracranial - complications ; Vasospasm, Intracranial - drug therapy ; Ventricle</subject><ispartof>Clinical neurology and neurosurgery, 2021-07, Vol.206, p.106705-106705, Article 106705</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. All rights reserved.</rights><rights>2021. Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-399ea97510273b38eee6cb78f80e983fd5b17c187db639735fb5276cc57e78b03</citedby><cites>FETCH-LOGICAL-c396t-399ea97510273b38eee6cb78f80e983fd5b17c187db639735fb5276cc57e78b03</cites><orcidid>0000-0003-3856-1623 ; 0000-0002-8606-961X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2539176369?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994,64384,64386,64388,72240</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34053805$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zeitouni, Daniel</creatorcontrib><creatorcontrib>Parish, Jonathan M.</creatorcontrib><creatorcontrib>Smith, Margaret</creatorcontrib><creatorcontrib>Stetler, William R.</creatorcontrib><creatorcontrib>Bernard, Joe D.</creatorcontrib><title>Reversible cerebral vasoconstriction syndrome successfully treated by intrathecal nicardipine</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>Reversible cerebral vasoconstriction syndrome (RCVS) presents with a thunderclap headache, often prompting brain imaging. Most patients fully recover with supportive care and time, but oral calcium channel blockers are often used in patients with severe vasoconstriction. In this case report, we present a patient with severe vasoconstriction leading to weakness refractory to oral calcium channel blockers. Intrathecal nicardipine was administered via an external ventricular drain and the patient subsequently showed improvement of her weakness and significant improvement of vasospasm on Computed Tomography Angiography. We suggest further studies to determine the efficacy of intrathecal nicardipine in patients with RCVS not responsive to oral calcium channel blockers.
•Reversible cerebral vasoconstriction syndrome (RCVS) is an under-diagnosed cause of severe headache.•Oral calcium channel blockers can be used for severe cases.•Intrathecal calcium channel blockers via EVD have been used to treat aneurysmal vasospasm.•Intrathecal nicardipine may be a treatment option for cases of refractory RCVS with neurologic deficit.</description><subject>Adult</subject><subject>Angiography</subject><subject>Angioplasty</subject><subject>Blood pressure</subject><subject>Calcium</subject><subject>Computed tomography</subject><subject>Female</subject><subject>Headache</subject><subject>Headache Disorders, Primary - etiology</subject><subject>Headaches</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Infections</subject><subject>Injections, Spinal</subject><subject>Neuroimaging</subject><subject>Neurology</subject><subject>Nicardipine - administration & dosage</subject><subject>Pathophysiology</subject><subject>Patients</subject><subject>Reversible Cerebral Vasoconstriction Syndrome</subject><subject>Syndrome</subject><subject>Vasoconstriction</subject><subject>Vasodilator Agents - administration & dosage</subject><subject>Vasospasm</subject><subject>Vasospasm, Intracranial - complications</subject><subject>Vasospasm, Intracranial - drug therapy</subject><subject>Ventricle</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUtrGzEUhUVJady0fyEMZJPNuNIoeu0SQl8QKJR2WYR05w6VGUuOpDH431fGSRfZZHXh8p37OIeQS0bXjDL5abOGOURccloPdGCtKRUVb8iKaTX00kh9RlaUU97rG6nOyftSNpRSzqV-R875DRVcU7Eif37iHnMJfsYOMKPPbu72riRIsdQcoIYUu3KIY05b7MoCgKVMyzwfuprRVRw7f-hCrNnVvwhNHQO4PIZdO-8DeTu5ueDHp3pBfn_5_Ov-W__w4-v3-7uHHriRtefGoDNKMDoo7rlGRAle6UlTNJpPo_BMQfts9JIbxcXkxaAkgFCotKf8glyf5u5yelywVLsNBXCeXcS0FDsILtgwCC0aevUC3aQlx3bdkTJMSS5No-SJgpxKyTjZXQ5blw-WUXsMwG7scwD2GIA9BdCEl0_jF7_F8b_s2fEG3J4AbH7sA2ZbIGAEHENGqHZM4bUd_wDV55vJ</recordid><startdate>202107</startdate><enddate>202107</enddate><creator>Zeitouni, Daniel</creator><creator>Parish, Jonathan M.</creator><creator>Smith, Margaret</creator><creator>Stetler, William R.</creator><creator>Bernard, Joe D.</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3856-1623</orcidid><orcidid>https://orcid.org/0000-0002-8606-961X</orcidid></search><sort><creationdate>202107</creationdate><title>Reversible cerebral vasoconstriction syndrome successfully treated by intrathecal nicardipine</title><author>Zeitouni, Daniel ; Parish, Jonathan M. ; Smith, Margaret ; Stetler, William R. ; Bernard, Joe D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-399ea97510273b38eee6cb78f80e983fd5b17c187db639735fb5276cc57e78b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Angiography</topic><topic>Angioplasty</topic><topic>Blood pressure</topic><topic>Calcium</topic><topic>Computed tomography</topic><topic>Female</topic><topic>Headache</topic><topic>Headache Disorders, Primary - etiology</topic><topic>Headaches</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Infections</topic><topic>Injections, Spinal</topic><topic>Neuroimaging</topic><topic>Neurology</topic><topic>Nicardipine - administration & dosage</topic><topic>Pathophysiology</topic><topic>Patients</topic><topic>Reversible Cerebral Vasoconstriction Syndrome</topic><topic>Syndrome</topic><topic>Vasoconstriction</topic><topic>Vasodilator Agents - administration & dosage</topic><topic>Vasospasm</topic><topic>Vasospasm, Intracranial - complications</topic><topic>Vasospasm, Intracranial - drug therapy</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zeitouni, Daniel</creatorcontrib><creatorcontrib>Parish, Jonathan M.</creatorcontrib><creatorcontrib>Smith, Margaret</creatorcontrib><creatorcontrib>Stetler, William R.</creatorcontrib><creatorcontrib>Bernard, Joe D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neurology and neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zeitouni, Daniel</au><au>Parish, Jonathan M.</au><au>Smith, Margaret</au><au>Stetler, William R.</au><au>Bernard, Joe D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reversible cerebral vasoconstriction syndrome successfully treated by intrathecal nicardipine</atitle><jtitle>Clinical neurology and neurosurgery</jtitle><addtitle>Clin Neurol Neurosurg</addtitle><date>2021-07</date><risdate>2021</risdate><volume>206</volume><spage>106705</spage><epage>106705</epage><pages>106705-106705</pages><artnum>106705</artnum><issn>0303-8467</issn><eissn>1872-6968</eissn><abstract>Reversible cerebral vasoconstriction syndrome (RCVS) presents with a thunderclap headache, often prompting brain imaging. Most patients fully recover with supportive care and time, but oral calcium channel blockers are often used in patients with severe vasoconstriction. In this case report, we present a patient with severe vasoconstriction leading to weakness refractory to oral calcium channel blockers. Intrathecal nicardipine was administered via an external ventricular drain and the patient subsequently showed improvement of her weakness and significant improvement of vasospasm on Computed Tomography Angiography. We suggest further studies to determine the efficacy of intrathecal nicardipine in patients with RCVS not responsive to oral calcium channel blockers.
•Reversible cerebral vasoconstriction syndrome (RCVS) is an under-diagnosed cause of severe headache.•Oral calcium channel blockers can be used for severe cases.•Intrathecal calcium channel blockers via EVD have been used to treat aneurysmal vasospasm.•Intrathecal nicardipine may be a treatment option for cases of refractory RCVS with neurologic deficit.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>34053805</pmid><doi>10.1016/j.clineuro.2021.106705</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-3856-1623</orcidid><orcidid>https://orcid.org/0000-0002-8606-961X</orcidid></addata></record> |
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| ispartof | Clinical neurology and neurosurgery, 2021-07, Vol.206, p.106705-106705, Article 106705 |
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| subjects | Adult Angiography Angioplasty Blood pressure Calcium Computed tomography Female Headache Headache Disorders, Primary - etiology Headaches Hemorrhage Humans Infections Injections, Spinal Neuroimaging Neurology Nicardipine - administration & dosage Pathophysiology Patients Reversible Cerebral Vasoconstriction Syndrome Syndrome Vasoconstriction Vasodilator Agents - administration & dosage Vasospasm Vasospasm, Intracranial - complications Vasospasm, Intracranial - drug therapy Ventricle |
| title | Reversible cerebral vasoconstriction syndrome successfully treated by intrathecal nicardipine |
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