Segmental cerebral vasoconstriction: successful treatment of secondary cerebral ischaemia with intravenous prostacyclin

Cephalalgia : an International Journal of Headache
Per-Olof GrändeMats Cronqvist

Abstract

We describe a 23-year-old male patient who presented with spontaneous intermittent and increasing attacks of severe, left-sided thunderclap headache combined with rapidly progressive muscle weakness and dysphasia, including gradual loss of consciousness. Subsequent CT, MRI and DSA showed progressive brain ischaemia and oedema within the left cerebral hemisphere with strict ipsilateral segmental arterial vasoconstriction. Despite extensive medical care, including steroids, the patient deteriorated rapidly. However, the clinical course changed dramatically within 15 h after the start of an intravenous infusion of prostacyclin at a dose of 0.9 ng/kg/min, with an almost complete recovery of consciousness and speech. In addition the pathophysiological alterations seen on magnetic resonance (imaging and digital) subtraction angiography including diffusion-weighted imaging and apparent diffusion coefficient maps shortly before prostacyclin treatment were clearly reduced when the patient was examined 3-4 days later and he continued to recover thereafter. Although not fully compatible, our case had several clinical characteristics and radiological findings reminiscent of those of the 'segmental reversible vasoconstriction syndrome', som...Continue Reading

References

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Aug 29, 2000·Cephalalgia : an International Journal of Headache·J W Sturm, R A Macdonell
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Jul 24, 2008·Headache·Manon BouchardNicolas Dupré

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Citations

Dec 20, 2012·Current Neurology and Neuroscience Reports·Arnaldo Velez, James S McKinney
Apr 16, 2013·Current Pain and Headache Reports·Siddharth Kapoor
Aug 21, 2014·Current Pain and Headache Reports·Ali Mehdi, Rula A Hajj-Ali
Jan 17, 2015·AJNR. American Journal of Neuroradiology·T R MillerD Gandhi
Nov 22, 2014·Stroke; a Journal of Cerebral Circulation·Rune RasmussenNiels Vidiendal Olsen
Aug 26, 2011·Expert Review of Neurotherapeutics·Shih-Pin ChenShuu-Jiun Wang

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Methods Mentioned

BETA
PCA

Software Mentioned

Lund perfusion program ( LUPE )

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