Background and objectives

RCVS (Reversible Cerebral Vasoconstrictive Syndrome) is a condition associated with vasoactive agents that alter endothelial function. There is growing evidence that endothelial inflammation contributes to cerebrovascular disease in patients with coronavirus disease 2019 (COVID-19). In our study, we describe the clinical features, risk factors, and outcomes of RCVS in a multicenter case series of patients with COVID-19.

Materials and methods

Multicenter retrospective case series. We collected clinical characteristics, imaging, and outcomes of patients with RCVS and COVID-19 identified at each participating site.

Results

Ten patients were identified, 7 women, ages 21 – 62 years. Risk factors included use of vasoconstrictive agents in 7 and history of migraine in 2. Presenting symptoms included thunderclap headache in 5 patients with recurrent headaches in 4. Eight were hypertensive on arrival to the hospital. Symptoms of COVID-19 included fever in 2, respiratory symptoms in 8, and gastrointestinal symptoms in 1. One patient did not have systemic COVID-19 symptoms. MRI showed subarachnoid hemorrhage in 3 cases, intraparenchymal hemorrhage in 2, acute ischemic stroke in 4, FLAIR hyperintensities in 2, and no abnormalities in 1 case. Neurovascular imaging showed focal segment irregularity and narrowing concerning for vasospasm of the left MCA in 4 cases and diffuse, multifocal narrowing of the intracranial vasculature in 6 cases. Outcomes varied, with 2 deaths, 2 remaining in the ICU, and 6 surviving to discharge with modified Rankin scale (mRS) scores of 0 (n=3), 2 (n=2), and 3 (n=1).

Conclusions

Our series suggests that patients with COVID-19 may be at risk for RCVS, particularly in the setting of additional risk factors such as exposure to vasoactive agents. There was variability in the symptoms and severity of COVID-19, clinical characteristics, abnormalities on imaging, and mRS scores. However, a larger study is needed to validate a causal relationship between RCVS and COVID-19.

中文翻译：

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冠状病毒病患者的可逆性脑血管收缩综合征：多中心病例系列

背景和目标

RCVS（可逆性脑血管收缩综合征）是一种与改变内皮功能的血管活性剂相关的病症。越来越多的证据表明，内皮炎症会导致 2019 年冠状病毒病 (COVID-19) 患者的脑血管疾病。在我们的研究中，我们描述了 RCVS 在 COVID-19 患者的多中心病例系列中的临床特征、危险因素和结果。

材料和方法

多中心回顾性病例系列。我们收集了每个参与中心发现的 RCVS 和 COVID-19 患者的临床特征、影像学和结果。

结果

确定了 10 名患者，其中 7 名女性，年龄在 21 至 62 岁之间。危险因素包括 7 例使用血管收缩剂和 2 例偏头痛病史。5 例患者的症状包括霹雳样头痛，4 例患者出现反复头痛。8 例患者入院时患有高血压。COVID-19 的症状包括 2 例发烧、8 例呼吸道症状和 1 例胃肠道症状。一名患者没有全身性 COVID-19 症状。MRI示蛛网膜下腔出血3例，脑实质出血2例，急性缺血性脑卒中4例，FLAIR高信号2例，无异常1例。神经血管成像显示 4 例与左侧 MCA 血管痉挛有关的局灶节段不规则和狭窄，6 例颅内血管系统弥漫性多灶性狭窄。结果各不相同，有 2 人死亡，

结论

我们的系列研究表明，COVID-19 患者可能存在 RCVS 风险，尤其是在存在其他风险因素（例如接触血管活性药物）的情况下。COVID-19 的症状和严重程度、临床特征、影像学异常和 mRS 评分存在差异。然而，需要更大规模的研究来验证 RCVS 和 COVID-19 之间的因果关系。