Intra-arterial application of nimodipine in reversible cerebral vasoconstriction syndrome: A diagnostic tool in select cases?

University Hospital Munich, Germany.
Cephalalgia (Impact Factor: 4.89). 07/2011; 31(10):1074-81. DOI: 10.1177/0333102410394673
Source: PubMed


Differential diagnoses of the reversible cerebral vasoconstriction syndrome (RCVS) include all forms of intracranial stenotic disease, such as primary or secondary vasculitis of the central nervous system. Here, we tested the hypothesis that angiographic response to intra-arterial nimodipine application may be helpful in differentiating between RCVS and other entities.
A digital subtraction angiographic (DSA) series of nine consecutive patients with suspected RCVS that were treated by intra-arterial nimodipine due to clinical worsening were retrospectively analyzed. Pre- and post-therapeutic DSA findings of patients with later-confirmed RCVS were compared to those in which another diagnosis was finally made.
Intra-arterial nimodipine resulted in a normalization of both the diameter of the main trunks of the cerebral vessels and the caliber of the peripheral vessels in all RCVS patients. This was not the case in the non-RCVS patients, in whom only a slight general vasodilatation was observed.
Our preliminary results indicate that angiographic response to intra-arterial application might be a helpful differential diagnostic tool in select patients with suspected RCVS.

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    • "It has been hypothesized that either the episodes of systemic hypertension lead to hyperperfusion, or cerebral vasoconstriction and therefore hypoperfusion result in vasogenic edema observed in PRES [52]. Mainstay of treatment remains calcium-channel blockers including intravenous nimodipine [49••], intravenous prostacyclin [53] and intra-arterial delivery of milrinone [54], nimodipine [55], verapamil [56] that have been reported to be beneficial. "
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    ABSTRACT: Cranial or cervical vascular disease is commonly associated with headaches. The descriptions may range from a thunderclap onset of a subarachnoid hemorrhage to a phenotype similar to tension type headache. Occasionally, this may be the sole manifestation of a potentially serious underlying disorder like vasculitis. A high index of clinical suspicion is necessary to diagnose the disorder. Prompt recognition and treatment is usually needed for many conditions to avoid permanent sequelae that result in disability. Treatments for many conditions remain challenging and are frequently controversial due to paucity of well controlled studies. This is a review of the recent advances that have been made in the diagnosis or management of these secondary headaches.
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    • "Intra-arterial (IA) vasodilators injected during DSA with and without angioplasty are also used. These include IA milrinone [30], IA verapamil [32], and IA nimodipine as both a therapeutic and diagnostic agent [33], with the evidence, again, limited to case reports. IA verapamil has been shown to improve radiological vasospasm [34, 35], but whether this translates to improved clinical outcomes remains to be proven. "
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    ABSTRACT: Reversible cerebral vasoconstriction syndrome (RCVS) is an increasingly recognized and important cause of acute headache. The majority of these patients develop potentially serious neurological complications. Rigorous investigation is required to exclude other significant differential diagnoses. Differentiating RCVS from subarachnoid haemorrhage (SAH) and primary angiitis of the central nervous system (PACNS) may be difficult but has important therapeutic implications. This paper describes what is currently known about the epidemiology, pathophysiology, clinical, and diagnostic features of the syndrome, an approach to investigation, a summary of treatments, and what is known of prognosis.
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  • Cephalalgia 06/2011; 31(10):1067-70. DOI:10.1177/0333102411410084 · 4.89 Impact Factor
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