We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Reversible Cerebral Vasoconstriction Syndrome and Hemorrhagic Events: Who Precedes Whom?—Reply

Aneesh B. Singhal, MD
Arch Neurol. 2011;68(12):1614-1615. doi:10.1001/archneur.68.12.1615-a.
Text Size: A A A
Published online


In reply

We thank Zhang and colleagues for their comments. While potential mechanisms were not addressed in detail in our article,1 we and others have previously proposed that RCVS-associated brain hemorrhage results from dynamic arterial caliber changes that cause postischemic reperfusion injury or abrupt vasodilatation and rupture of small arteries.13 Several observations support this hypothesis. First, RCVS-associated lobar hemorrhages are usually located in arterial watershed regions and often coexist with ischemic lesions, suggesting that ischemia-reperfusion injury is an important mechanism. Second, reversible brain edema can precede RCVS-associated brain hemorrhage, suggesting that the vascular process initially involves small vessels that are beyond the resolution of angiography. Indeed, Ducros et al4 have shown that RCVS is a dynamic arteriopathy, with the more proximal arteries becoming affected later. Hence, it is not a prerequisite, as suggested by Zhang and colleagues, to document vasoconstriction prior to brain hemorrhage in order to prove our hypothesis.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





December 1, 2011
Hongliang Zhang, MD; Xiaoke Wang, MD; Yi Yang, MD, PhD; Jiang Wu, MD, PhD
Arch Neurol. 2011;68(12):1614-1615. doi:10.1001/archneur.68.12.1614-b.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Clubbing with ecstasy. Temperature (Austin) ;1(3):160-1.