Reversible cerebral vasoconstriction syndrome: Transcranial doppler findings in a case series of 90 patients

Abstract

Background

Transcranial Doppler (TCD) can be used in the diagnosis and monitoring of reversible cerebral vasoconstriction syndrome (RCVS). Whether TCD abnormalities can extend beyond 8–12 weeks has not been studied. We performed a single-center, retrospective analysis of TCD abnormalities in RCVS, specifically, whether elevated mean flow velocities (MFV) can persist beyond 90 days of symptom onset.

Methods

Consecutive patients were identified retrospectively using our hospital coding and billing data, and EMR search (2012–2023). Inclusion criteria were diagnosis of RCVS, any age, and available Spectral TCD (non-imaging) (TCD-S). Exclusion criteria were RCVS patients without TCD-S studies, or patients deemed to have other vasculopathies upon adjudication. We recorded demographics, RCVS triggers, and clinical and imaging features. Presence of elevated MFV on TCD-S above the upper reference range was considered abnormal.

Results

Ninety patients with RCVS had TCD-S performed (mean age 39.8 ± 11.8 years, 91% female). Six patients (6.7%) were pregnant and 25 (27.8%) were postpartum. Vasoconstriction was seen on imaging in 56 (62.2%). Median RCVS₂ score was 9 (7–10). Complications of RCVS included subarachnoid hemorrhage in 25 (27.8%), intracerebral hemorrhage in 19 (21.1%), and cerebral infarction in 11 (12.2%). TCD-S was abnormal (elevated MFV) in seventy-nine (87.8%). Among those with serial (≥2) TCD-S (n = 67), twenty-two (32.8%) had normalization in MFV at a median time of 73 days (50–132) from symptom onset. Forty-five (67.2%) did not show normalization as per their last available TCD-S at a median of 41 days (16–177). Twenty-six (31.9%) patients had available TCD-S results beyond 90 days, of which 21 (81%) had elevated MFV.

Conclusions

Patients with RCVS can have elevated TCD-S mean flow velocities beyond 90 days. TCD-S may have utility in the diagnosis of RCVS in the early or mild cases, where CTA or MRA may not capture the vasospasm. Prospective studies of the duration of TCD-S abnormalities are necessary to confirm these findings, and to inform clinical management, such as the duration of follow-up and the effects of calcium channel blocker treatment.