Intra-arterial milrinone may differentiate fulminant RCVS from vasculitis

A 39-year-old woman taking a monoamine oxidase inhibitor presented with a 1-week history of severe non-thunderclap headache and visual field deficits. Brain CT showed infarcts in both parietal lobes, with narrowing of intracranial vessels on CT angiogram (figure 1), suggesting either vasculitis or reversible cerebral vasoconstriction syndrome (RCVS). Despite treatment with both methylprednisolone and nimodipine, she experienced progressive aphasia and right leg weakness. She underwent an urgent cerebral angiogram (figure 2), during which intra-arterial milrinone reversed both the vasoconstriction and its symptoms, thereby confirming RCVS. Intra-arterial milrinone may be useful to differentiate vasculitis from RCVS1 and may serve as a treatment for RCVS, but requires prospective evaluation.

Source: Neurology - September 4, 2017 Category: Neurology Authors: Laneuville, M., Ding, J., Shamy, M., Lum, C., Dowlatshahi, D. Tags: All Headache, Other cerebrovascular disease/ Stroke NEUROIMAGES Source Type: research