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Cephalalgia. 2018 May;38(6):1207-1210. doi: 10.1177/0333102417731779. Epub 2017 Sep 14.

Isolated cortical vasogenic edema and hyperintense vessel signs may be early features of reversible cerebral vasoconstriction syndrome: Case reports.

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1 Department of Neurology, 290702 Osaka University Graduate School of Medicine , Suita, Osaka, Japan.
2 Department of Neurology, 26330 Kobe City Medical Center General Hospital , Kobe, Hyogo, Japan.


Background The temporal and anatomical features of vasoconstriction in patients with reversible cerebral vasoconstriction syndrome within hours after symptom onset, in the hyperacute phase, are unclear. Case result Herein we report the cases of two patients with acute severe headache who were diagnosed with reversible cerebral vasoconstriction syndrome. Magnetic resonance imaging within hours after symptom onset revealed multiple areas of isolated cortical vasogenic edema and hyperintense vessel signs of the distal cerebral arteries. Follow-up imaging performed four days later in both cases showed diffuse segmental arterial vasoconstriction in the proximal regions of the cerebral arteries. Both patients received antivasoconstrictive therapy shortly after admission, and neither had neurological sequelae at discharge. The magnetic resonance imaging findings improved gradually within three months after symptom onset. Conclusion Isolated cortical vasogenic edema and hyperintense vessel signs, when observed within hours from sudden severe headache onset, may be useful early markers of reversible cerebral vasoconstriction syndrome.


Reversible cerebral vasoconstriction syndrome; hyperacute phase; hyperintense vessel signs; vasogenic edema


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