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J Clin Neurosci. 2012 Jan;19(1):174-6. doi: 10.1016/j.jocn.2011.06.016. Epub 2011 Nov 25.

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

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Department of Neurology and Clinical Neurosciences, Clinical Neurosciences Center, University of Utah Hospitals and Clinics, 175 N Medical Drive East, Salt Lake City 84132, UT, USA.


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.

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