Abstract
Background/Objectives Reversible Cerebral Vasoconstriction Syndrome (RCVS) is characterised by recurrent, transient cerebral vasoconstriction which is typically self-limited and associated with complete recovery in most patients. Mild disability has been reported in less than 30% of patients in the long term.1 While there is a paucity of recommendations for specific treatment protocols, oral nimodipine and verapamil have been used for supportive care and symptom relief. For fulminant cases which are refractory to oral treatments and show evidence of neurologic complications, intraarterial treatment with vasodilators have been used1. We present two recent cases of severe RCVS with neurologic deterioration which were treated with intraarterial calcium channel blockers resulting in outcomes of functional independence for both patients.
Methods A literature review was conducted using MEDLINE and PubMed using the key words ‘RCVS’, ‘Treatment’, ‘Intra-arterial injection’. The available case reports and systematic reviews were considered. Patient files were accessed using the Integrated Electronic Medical Records (ieMR) system.
Conclusion/Discussion In both cases, intraarterial vasodilators resulted in prompt reversal of vasoconstriction and preceded good clinical outcomes. Robust evidence to recommend intraarterial vasodilatory injection for the treatment of RCVS is lacking however several case reports have been published detailing this approach and the clinical outcomes which followed. Further research is required for risk stratification of RCVS to guide the early implantation of intraarterial vasodilation to avoid permanent neurological injury.
Reference
Nesheiwat O, Al-Khoury L. Reversible cerebral vasoconstriction syndromes. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551723/
