Premium
Type of headache at onset and risk for complications in reversible cerebral vasoconstriction syndrome
Author(s) -
Lange Kristin Sophie,
Forster Ophélie,
Mawet Jérôme,
Tuloup Gabrielle,
Burcin Cécilia,
Corti Lucas,
Duflos Claire,
Roos Caroline,
Ducros Anne
Publication year - 2022
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.15064
Subject(s) - medicine , reversible cerebral vasoconstriction syndrome , modified rankin scale , posterior reversible encephalopathy syndrome , subarachnoid hemorrhage , complication , cohort , pediatrics , anesthesia , surgery , magnetic resonance imaging , ischemia , ischemic stroke , radiology
Background In a recent Italian study, 30% of patients with reversible cerebral vasoconstriction syndrome (RCVS) presented without thunderclap headache (TCH), and tended to present more severe forms of RCVS than patients with TCH. We aimed to analyze the risk for complications of RCVS in patients with and without TCH at onset. Methods In a pooled cohort of 345 French patients with RCVS, we compared patients with and without TCH at onset regarding rates of neurological complications, and the functional outcome at 3 months. Results As compared to the 281 patients with TCH at onset, the 64 patients without TCH had a higher risk for any neurological complication (61% vs. 24%, OR 4.9, 95% CI 2.8–8.7, p < 0.001). The association was strongest for cervical artery dissections (28% vs. 5%, OR 8.1, 95% CI 3.7–17.6, p < 0.001), followed by posterior reversible encephalopathy syndrome (17% vs. 3%, OR 7.1, 95% CI 2.7–18.4, p < 0.001), seizures (9% vs. 2.5%, OR 4.1, 95% CI 1.3–12.5, p = 0.019), and subarachnoid hemorrhage (41% vs. 16%, OR 3.5, 95% CI 1.9–6.3, p < 0.001). In multivariable analysis, the risk for any neurological complication remained significantly elevated in the absence of TCH (OR 3.5, 95% CI 1.8–6.8, p < 0.001). The functional outcome was equal in both groups, with a modified Rankin scale score of 0–1 in ≥90% of patients. Conclusions Absence of TCH at onset might predict a higher risk of complications in RCVS. Our results warrant further multicentric studies to prove this finding.