Stroke Literature Synopses: Clinical Science
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Singhal et al (Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome. Neurology. 2017;88:228–236.)
Although most individuals with reversible cerebral vasoconstriction syndrome (RCVS) have excellent outcomes, 5% to 14% do poorly (discharge modified Rankin Scale score>3). Singhal et al conducted a single-center retrospective study (1998–2016; n=162) to identify predictors of persistent clinical worsening (development of new persistent focal or cognitive deficits or abrupt worsening of existing deficits), radiological worsening (occurrence of new lesion on any follow-up brain scan), early angiographic progression (worsened overall angiographic appearance on cerebral angiograms performed within 30 days of baseline compared with immediately prior study), and poor discharge outcome (modified Rankin Scale score, 4–6).
The mean age of the cohort was 44±13 years; 78% were women. Persistent clinical worsening occurred in 14% at 6.6±4.1 days after symptom onset, radiological worsening in 27% (mainly new infarcts), and angiographic progression in 15%. Individuals with clinical worsening were mostly women, with higher rates of hypertension, depression, exposure to serotonergic antidepressants, higher rates of treatment with intra-arterial vasodilators, and immunosuppressive agents, such as glucocorticoids and cyclophosphamide. Clinical worsening correlated with angiographic progression, new nonhemorrhagic lesions, longer duration of hospitalization, and worse …