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Reversible Cerebral Vasoconstriction Syndrome After Blood Transfusion
Author(s) -
Dou YiHsuan,
Fuh JongLing,
Chen ShihPin,
Wang ShuuJiun
Publication year - 2014
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12319
Subject(s) - medicine , reversible cerebral vasoconstriction syndrome , posterior reversible encephalopathy syndrome , blood transfusion , anemia , complication , anesthesia , vasoconstriction , surgery , magnetic resonance imaging , radiology
Objectives To report 2 cases of reversible cerebral vasoconstriction syndrome ( RCVS ) with posterior reversible encephalopathy syndrome ( PRES ) after blood transfusion for severe anemia. Background RCVS is presented with recurrent thunderclap headache and reversible constriction of cerebral arteries. PRES is a known complication of RCVS . Blood transfusion for severe anemia could be a cause for PRES in few cases; however, it is seldom mentioned as an etiology for RCVS . Methods We report a case series. Results We report 2 women presented with RCVS with PRES after blood transfusion for anemia, and reviewed another 4 similar cases reported in the literature. Our 2 patients were middle‐aged women, with severe chronic anemia (average hemoglobin: 1.45 g/dL), and received multiple blood transfusions (average: 3250 mL) over a period of 5‐7 days. They developed thunderclap headache and other symptoms about 1 week after the last blood transfusion. Cerebral vasoconstrictions were demonstrated by magnetic resonance angiography and transcranial color‐coded sonography. PRES was found in both of them using magnetic resonance imaging, and one of them also had cytotoxic edema on diffusion weighted image. Conclusions RCVS with PRES is one complication of blood transfusion in patients under chronic severe anemia (especially when hemoglobin level increased for more than 5 g/dL), particularly in A sian women with menorrhagia. Blood pressure surge and the occurrence of severe headaches or other neurological symptoms should be aggressively monitored within 10 days after the last blood transfusion.