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Ssri sexual dysfunction reversible cerebral vasoconstriction

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A prospective series of 67 patients, BrainVolumeIssue 12, 1 DecemberPages —, https: We present the clinical, neuroimaging and outcome data of 67 consecutive patients prospectively diagnosed over 3 years in our institution with an angiographically confirmed RCVS. There were 43 females and 24 males with a mean age of 42 years 19— Various complications were observed, with different time courses. Significant sex differences were observed: Sixty-one patients were treated by nimodipine: The different time courses of thunderclap headaches, vasoconstriction and strokes suggest that the responsible vasospastic disorder starts distally and progresses towards medium sized and large arteries.

Our data suggest that RCVS is more frequent than previously thought, is more often secondary particularly to vasoactive substances, and should be considered in patients with recurrent thunderclap headaches, cSAH or cryptogenic strokes with severe headaches.

Patients with these features were previously reported under many appellations Table 1. The most common clinical feature of RCVS is a severe acute headache, often qualifying as thunderclap headache Dodick Ssri sexual dysfunction reversible cerebral vasoconstriction al.

The major complication of RCVS is stroke, -ischaemic or haemorrhagic- eventually leading to permanent sequelae and even death Singhal et al. Non-aneurismal cortical subarachnoid haemorrhage cSAH has been less-frequently reported Singhal, b ; Sengoku et al. Although the pathophysiology of RCVS remains unknown, the prevailing hypothesis involves a transient disturbance in the control of cerebral Ssri sexual dysfunction reversible cerebral vasoconstriction tone Schwedt et al. RCVS has a female Ssri sexual dysfunction reversible cerebral vasoconstriction Chen et al.

It may occur spontaneously or be provoked by various precipitating factors, the most common being postpartum Singhal and Bernstein, and exposure to various vasoactive substances Table 2 Bousser et al. Angiography had to be repeated after a few weeks or months to demonstrate the normalization of cerebral arteries. More recently, non-invasive investigations such as magnetic resonance angiography MRA and transcranial Doppler TCD have been largely used for the assessment and follow-up of vasoconstriction Bogousslavsky et al.

The growing interest in RCVS is reflected by the recent publication of numerous case-reports, retrospective small series and reviews Calabrese et al. However, only two studies including more than 10 patients have so far been published: We present herein the first large prospective study of RCVS, based on the 67 consecutive patients with angiographically proven reversible vasoconstriction who were prospectively diagnosed in our institution in the last 3 years.

Patients who satisfied the three following diagnostic criteria for RCVS were included: From January to January67 consecutive patients satisfying these criteria were prospectively recruited in our institution, 51 from the emergency headache centre, and 16 from the neurology department.

All patients but one were hospitalized in the neurology department for further investigations see below. The remaining patient was managed as an outpatient. All patients were directly interviewed by the same neurologist A. They were informed that they were included in a descriptive study and agreed to participate.

Introduction

The following data were collected: Headache intensity was evaluated by using a verbal scale ranging from 0 no pain to 10 the maximum pain that you can ever imagine. Diagnosis of primary headache disorders was made according to the criteria of the International Headache Society IHS, RCVS was qualified as secondary in the presence of a potential precipitating factor and spontaneous when none could be identified. Neuroimaging investigations were performed within 48 h after arrival in our institution.

No standard treatment protocol was used. Symptomatic analgesic treatment was used in all patients. A first clinical follow-up visit was performed in all patients within 3—6 weeks after discharge. Further follow-up clinical visits were performed 6 and 12 months after disease onset, then every year.

For the purpose of the study, all patients were assessed again by telephone interview in March Data are presented as mean and SD or as frequency and percent. Categorical variables were Ssri sexual dysfunction reversible cerebral vasoconstriction across groups using Fisher's exact tests or Chi-square tests for trend for ordered categories.

Continuous variables were compared across groups using Student t -tests. Gender-related differences concerning vasoactive medications were studied comparing non-postpartum women and men. Mean delays from headache onset to haemorrhagic intracerebral haemorrhage or cortical subarachnoid haemorrhage or ischaemic transient ischaemic attacks and cerebral infarction events were compared using linear mixed models with random subject effects, to account for a possible correlation between delays observed on a same patient.

Cumulative incidence curves of these events event probability over time were estimated using Kaplan—Meier method, as no competing event occurred no deaths during the first month of follow-up. All tests were two-sided. All analyses Ssri sexual dysfunction reversible cerebral vasoconstriction carried out using R 2. The demographic data of the 67 patients are indicated in Table 3.

Reversible cerebral vasoconstriction syndrome (RCVS)...

There was a female preponderance female: The mean age was significantly higher in women than in men. In two, symptoms started concomitantly with the peridural injection of anaesthetics associated with epinephrine. In the remaining three women, there was a mean delay of 6. Only one received bromocriptine during 48 h after delivery to inhibit lactation Table 3. Exposure to vasoactive substances with or without alcoholcomparison of females not in postpartum and males.

Recent severe headache was by definition the presenting symptom in all cases. There was a mean delay of 7. Most patients described an excruciating pain peaking in less than 10 s: The maximal pain intensity was graded as a mean Ssri sexual dysfunction reversible cerebral vasoconstriction 9. Pain was often so severe that patients were agitated, crying or shouting and unable to speak more than a few words. Ten patients reported short-lasting thunderclap headaches of less than 1 h mean duration 26 min, range 5—50 min.

Pain location was bilateral in all but three patients. Among the 14 patients with focal deficits, 9 had only transient symptoms, 3 had a persistent deficit and 2 had both transient symptoms and a persistent deficit Tables 3 and 5.

Visual symptoms were the most frequent, followed by unilateral sensory symptoms, aphasia and hemiparesis. Twenty-three episodes in 9 patients were typical TIAs, whereas three mimicked a migraine aura with positive symptoms progressing over a few minutes.

In contrast, the other two subjects developed a brain infarction. One patient had an ischaemic stroke case 1. This woman had 10 thunderclap headaches from onset to day 12, before she developed on day 15 a left occipital infarct Ssri sexual dysfunction reversible cerebral vasoconstriction persisting right hemianopia and three sensory TIAs.

Three patients cases 2—4 had an intracerebral haemorrhage ICH.

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