An Epidemiological Analysis of Reversible Cerebral Vasoconstriction Syndrome: A Nationwide Database Study
Pranav Mirpuri1, Syed Khalid2, Mariyam Humayun3, Faten El Ammar2, Jared Davis3, Gursant Atwal3, Ciro Ramos-Estebanez3
1Rosalind Franklin University of Medicine and Science, Chicago Medical School, 2Department of Neurosurgery, University of Illinois Chicago, 3University of Illinois Chicago
Objective:
To describe the demographics, risk factors, and clinical manifestations of patients diagnosed with Reversible Cerebral Vasoconstriction Syndrome (RCVS).
Background:
RCVS is a condition characterized by multifocal constriction of cerebral arteries that presents with a wide array of clinical manifestations often with unknown etiology. Although the literature is growing, its incidence, risk factors, and manifestations are still not well established.
Design/Methods:
Through the PearlDiver Mariner database, RCVS patients were identified using ICD-10 codes. Along with patient demographics, the incidence of risk factors including current pregnancy, recent pregnancy within 6 weeks, history of migraine, presence of unruptured cerebral aneurysms, use of vasoconstrictive drugs (triptans, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), ergot derivatives) and recent cannabis use were analyzed. The incidence of clinical manifestations such as ischemic stroke, intracranial hemorrhage, transient ischemic attack (TIA), focal neurological deficits (hemiplegia, aphasia, visual deficits, ataxia), and seizure were also described.
Results:
Our population had an average age of 56.4 with a female preponderance at 69.2%. 19.9% of the population had a history of migraine, but the incidences of current or recent pregnancy (0% and 0.2%), and history of unruptured aneurysm (4.3%) were markedly lower. 9.1% of patients had used an SSRI within 45 days and 3.6% had used an SNRI, but only 1.82% had used cannabis within 3 months of presentation. The most common clinical manifestation was TIA at 22.9%, followed by ischemic stroke (13.8%) and intracerebral hemorrhage (12.7%).
Conclusions:
Given the heterogeneity of presenting features of RCVS, a high degree of clinical suspicion is required to avoid delaying care for patients. There was no risk factor identified that could account for the majority of RCVS cases in this population despite our analysis of “classic” causes like SSRI use and pregnancy, reflecting the need for further investigation into the etiology of this mysterious syndrome.