Reversible Cerebral Vasoconstriction Syndrome in Patients with Coronavirus Disease: A Multicenter Case Series

• Published in: Journal of stroke and cerebrovascular diseases 2021-12, Vol.30 (12), p.106118-106118, Article 106118
• Main Authors: Arandela, Kristine, Samudrala, Shilpa, Abdalkader, Mohamad, Anand, Pria, Daneshmand, Ali, Dasenbrock, Hormuzdiyar, Nguyen, Thanh, Ong, Charlene, Takahashi, Courtney, Shulman, Julie, Babi, Marc Alain, Sivakumar, Sanjeev, Shah, Neel, Jain, Sandip, Anand, Samyuktha, Nobleza, Christa O'Hana S., Shekhar, Shashank, Venkatasubramanian, Chitra, Salahuddin, Hisham, Taqi, Muhammad A., Nour, Hassan Aboul, Nofar, Justin B., Cervantes-Arslanian, Anna M.
• Format: Article
• Language: English
• Subjects: Adult; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - physiopathology; Cerebrovascular Circulation; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - therapy; Female; Humans; Male; Middle Aged; Neuroimaging; RCVS; Retrospective Studies; Risk Factors; SARS-CoV-2; Severity of Illness Index; Stroke; Syndrome; Time Factors; Treatment Outcome; United States; Vasoconstriction; Vasospasm, Intracranial - diagnostic imaging; Vasospasm, Intracranial - etiology; Vasospasm, Intracranial - physiopathology; Vasospasm, Intracranial - therapy; Young Adult
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106118

RCVS (Reversible Cerebral Vasoconstrictive Syndrome) is a condition associated with vasoactive agents that alter endothelial function. There is growing evidence that endothelial inflammation contributes to cerebrovascular disease in patients with coronavirus disease 2019 (COVID-19). In our study, we describe the clinical features, risk factors, and outcomes of RCVS in a multicenter case series of patients with COVID-19. Multicenter retrospective case series. We collected clinical characteristics, imaging, and outcomes of patients with RCVS and COVID-19 identified at each participating site. Ten patients were identified, 7 women, ages 21 – 62 years. Risk factors included use of vasoconstrictive agents in 7 and history of migraine in 2. Presenting symptoms included thunderclap headache in 5 patients with recurrent headaches in 4. Eight were hypertensive on arrival to the hospital. Symptoms of COVID-19 included fever in 2, respiratory symptoms in 8, and gastrointestinal symptoms in 1. One patient did not have systemic COVID-19 symptoms. MRI showed subarachnoid hemorrhage in 3 cases, intraparenchymal hemorrhage in 2, acute ischemic stroke in 4, FLAIR hyperintensities in 2, and no abnormalities in 1 case. Neurovascular imaging showed focal segment irregularity and narrowing concerning for vasospasm of the left MCA in 4 cases and diffuse, multifocal narrowing of the intracranial vasculature in 6 cases. Outcomes varied, with 2 deaths, 2 remaining in the ICU, and 6 surviving to discharge with modified Rankin scale (mRS) scores of 0 (n=3), 2 (n=2), and 3 (n=1). Our series suggests that patients with COVID-19 may be at risk for RCVS, particularly in the setting of additional risk factors such as exposure to vasoactive agents. There was variability in the symptoms and severity of COVID-19, clinical characteristics, abnormalities on imaging, and mRS scores. However, a larger study is needed to validate a causal relationship between RCVS and COVID-19.