Cerebral endothelial dysfunction in reversible cerebral vasoconstriction syndrome: a case-control study

• Published in: Journal of headache and pain Vol. 18; no. 1; p. 29
• Main Authors: Choi, Hyun Ah, Lee, Mi Ji, Chung, Chin-Sang
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.12.2017; Springer Nature B.V
• Subjects: Adult; Breath Holding; Case studies; Case-Control Studies; Cerebral Arterial Diseases - diagnostic imaging; Cerebral Arterial Diseases - physiopathology; Endothelium; Endothelium, Vascular - physiopathology; Female; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Migraine Disorders - diagnostic imaging; Migraine Disorders - physiopathology; Neurology; Pain Medicine; Pathology; Physiology; Prospective Studies; Research Article; Syndrome; Ultrasonography, Doppler, Transcranial; Vasoconstriction - physiology; Endothelial dysfunction; Reversible cerebral vasoconstriction syndrome; Pathophysiology; Breath holding index; Cerebral vasomotor reactivity
• ISSN: 1129-2369; 1129-2377
• DOI: 10.1186/s10194-017-0738-x

Background The aim of this study is to investigate cerebral endothelial dysfunction in patients with reversible cerebral vasoconstriction syndrome (RCVS). Methods We prospectively recruited patients with RCVS, age-matched controls with episodic migraine, and age-matched healthy controls at Samsung Medical Center from Apr 2015 to Jul 2016. All participants underwent transcranial Doppler evaluation, with a breath-holding maneuver, for the evaluation of bilateral middle cerebral arteries (MCAs), posterior cerebral arteries (PCAs), and the basilar artery (BA). The breath-holding index (BHI) was used to measure cerebral endothelium-dependent vasodilation. Follow-up BHIs were recorded in selected patients with RCVS after 3 months. Results A total of 84 subjects were recruited for this study ( n  = 28 in each group of RCVS, episodic migraine, and healthy control; mean age, 49.8 years). The RCVS group showed lower BHIs in all basal arteries, in comparison to healthy controls ( p  < 0.001, 0.009 for bilateral MCAs, p  < 0.001 and 0.028 for bilateral PCAs, and p  = 0.060 for the BA). Compared to migraineurs, RCVS patients had lower BHIs only in the anterior circulation ( p  = 0.002 and 0.038 for bilateral MCAs; p =  0.069 and 0.247 for bilateral PCAs; p =  0.120 for the BA). Of the 10 patients who had follow-up BHIs at 3 months, 7 showed complete normalization, while three did not. Conclusions Cerebral endothelial function is impaired in a widespread distribution in RCVS. Its role in the pathogenesis and clinical outcome of RCVS should be determined in further studies.