Department of Neurology
Adult; Aged; Cerebral Angiography; Cohort Studies; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Subarachnoid Hemorrhage; Tomography Scanners, X-Ray Computed; Vasospasm, Intracranial
Nervous System Diseases | Neurology
IMPORTANCE: Reversible cerebral vasoconstriction syndrome (RCVS) is a clinical-angiographic syndrome characterized by recurrent thunderclap headaches and reversible segmental multifocal cerebral artery narrowing. More than 30% of patients with RCVS develop subarachnoid hemorrhage (SAH). Patients with RCVS with SAH (RCVS-SAH) are often misdiagnosed as having potentially ominous conditions such as aneurysmal SAH (aSAH) or cryptogenic "angiogram-negative" SAH (cSAH) owing to overlapping clinical and imaging features.
OBJECTIVE: To identify predictors that can distinguish RCVS-SAH from aSAH and cSAH at the time of clinical presentation.
DESIGN: Retrospective analysis of 3 patient cohorts: patients with RCVS (1998-2009), patients with aSAH (1995-2003), and patients with cSAH (1995-2003).
SETTING: Academic hospital and tertiary referral center.
PARTICIPANTS: Consecutive patients with RCVS-SAH (n = 38), aSAH (n = 515), or cSAH (n = 93) whose conditions were diagnosed using standard criteria.
MAIN OUTCOMES AND MEASURES: Multivariate logistic regression analysis was used to identify predictors that differentiate RCVS-SAH from aSAH and cSAH.
RESULTS: Predictors differentiating RCVS-SAH from aSAH were younger age, chronic headache disorder, prior depression, prior chronic obstructive pulmonary disease, lower Hunt-Hess grade, lower Fisher SAH group, higher number of affected arteries, and the presence of bilateral arterial narrowing. Predictors differentiating RCVS-SAH from cSAH were younger age, female sex, prior hypertension, chronic headache disorder, lower Hunt-Hess grade, lower Fisher SAH group, and the presence of bilateral arterial narrowing.
CONCLUSIONS AND RELEVANCE: We identified important clinical and imaging differences between RCVS-SAH, aSAH, and cSAH that may be useful for improving diagnostic accuracy, clinical management, and resource utilization.
Rights and Permissions
Copyright American Medical Association. Publisher PDF posted as allowed by the publisher's author rights policy at http://archneur.jamanetwork.com/public/instructionsForAuthors.aspx.
DOI of Published Version
Muehlschlegel S, Kursun O, Topcuoglu MA, Fok J, Singhal AB. Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol. 2013 Oct;70(10):1254-60. PubMed PMID: 23939614. Link to article on publisher's site
Muehlschlegel, Susanne; Kursun, Oguzhan; Topcuoglu, Mehmet A.; Fok, Joshua; and Singhal, Aneesh B., "Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage" (2013). University of Massachusetts Medical School Faculty Publications. 775.