Repetitive use of intra-arterial verapamil in the treatment of reversible cerebral vasoconstriction syndrome

• Published in: Journal of clinical neuroscience Vol. 19; no. 1; pp. 174 - 176
• Main Authors: French, Kris F, Hoesch, Robert E, Allred, Juliann, Wilder, Michael, Smith, A.G, Digre, Kathleen B, La Barge, Donald V
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.01.2012
• Subjects: Adult; Aged, 80 and over; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - drug effects; Cerebral Arteries - pathology; Cerebrovascular Disorders - drug therapy; Cerebrovascular Disorders - etiology; Cerebrovascular Disorders - physiopathology; Female; Humans; Intra-arterial vasodilator therapy; Neurology; Radiography; Reversible cerebral vasoconstriction syndrome; Thunderclap headache; Treatment Outcome; Vasodilator Agents - administration & dosage; Vasospasm, Intracranial - drug therapy; Vasospasm, Intracranial - etiology; Vasospasm, Intracranial - physiopathology; Verapamil - administration & dosage; Reversible cerebral vasoconstriction syndrome; Intra-arterial vasodilator therapy; Thunderclap headache
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2011.06.016

Abstract Reversible cerebral vasoconstriction syndrome (RCVS) typically presents with recurrent thunderclap headaches and neurological deficits that are usually self-limiting. The intra-arterial (IA) use of vasodilators for RCVS has been reported for severe cases. Patients with RCVS have the potential for serious and permanent neurological deficits. It is a rare disorder, with a recent surge in the number of reports, and probably continues to be under-diagnosed. We report two patients with RCVS with severe neurological sequelae, treated in a large tertiary hospital. Both patients received high-dose cortico steroids due to the possibility of angiitis of the central nervous system, but they deteriorated neurologically, which suggests that steroids may have a deleterious effect in RCVS. Treatment with IA verapamil resulted in reversal of vasoconstriction, but multiple treatments were necessary. Therefore, IA administration of verapamil is a possible treatment for severe RCVS, but there is only limited sustained improvement in vasodilation that may require repetitive treatments with a currently undetermined optimal treatment interval.