Repetitive Use of Intra-Arterial Verapamil in the Treatment of Reversible Cerebral Vasoconstriction Syndrome

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

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.

Publication types

  • Case Reports

MeSH terms

  • 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
  • Radiography
  • Treatment Outcome
  • Vasodilator Agents / administration & dosage*
  • Vasospasm, Intracranial / drug therapy*
  • Vasospasm, Intracranial / etiology
  • Vasospasm, Intracranial / physiopathology
  • Verapamil / administration & dosage*

Substances

  • Vasodilator Agents
  • Verapamil