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Original Investigation |

Differentiating Reversible Cerebral Vasoconstriction Syndrome With Subarachnoid Hemorrhage From Other Causes of Subarachnoid Hemorrhage

Susanne Muehlschlegel, MD, MPH1; Oguzhan Kursun, MD2; Mehmet A. Topcuoglu, MD3; Joshua Fok, MD4; Aneesh B. Singhal, MD2
[+] Author Affiliations
1Departments of Neurology (Division of Neurocritical Care), Anesthesia/Critical Care and Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
2Department of Neurology (Stroke Service), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
3Department of Neurology, Hacettepe University, Ankara, Turkey
4Department of Neurology, Chinese University of Hong Kong
JAMA Neurol. 2013;70(10):1254-1260. doi:10.1001/jamaneurol.2013.3484.
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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.

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