Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome: Clinical and Radiological Considerations

Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are relatively uncommon neurological disorders, but their detection has been increasing mainly due to clinical awareness and spreading of magnetic resonance imaging (MRI). Because these syndromes share some common clinical and radiologic features and occasionally occur in the same patient, misdiagnosis may occur. PRES is characterized by varied neurological symptoms including headache, impaired visual acuity or visual field deficit, confusion, disorders of consciousness, seizures, and motor deficits often associated to peculiar neuroradiological pattern even if uncommon localization and ischemic or hemorrhagic lesions were described. RCVS is a group of diseases typically associated with severe headaches and reversible segmental vasoconstriction of cerebral arteries, often complicated by ischemic or hemorrhagic stroke. Pathophysiological basis of PRES and RCVS are still debated but, because they share some risk factors and clinical features, a possible common origin has been supposed. Clinical course is usually self-limiting, but prognosis may fluctuate from complete recovery to death due to complications of ischemic stroke or intracranial hemorrhage. Neuroradiological techniques such as digital angiography and MRI are helpful in the diagnostic pathway and a possible prognostic role of MRI has been suggested. This review will serve to summarize clinical, neuroradiologic...
Source: Frontiers in Neurology - Category: Neurology Source Type: research

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Moyamoya disease is a cerebrovascular disease of unknown origin causing progressive stenosis of the intracranial arteries in the circle of Willis.1,2 Stenoocclusive lesions and the subsequent hemodynamic compromise result in the formation of dilated, fragile collateral vessels at the base of the brain, which are termed moyamoya vessels. The presentation of patients with these lesions varies from asymptomatic to symptoms of headache, epilepsy, and ischemic and hemorrhagic stroke. Patients with moyamoya disease sometimes have concomitant extracranial arterial stenosis3; of all the extracranial arteries reported, the most com...
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Case Report Source Type: research
AbstractSpreading depolarization is observed as a large negative shift of the direct current potential, swelling of neuronal somas, and dendritic beading in the brain ’s gray matter and represents a state of a potentially reversible mass injury. Its hallmark is the abrupt, massive ion translocation between intraneuronal and extracellular compartment that causes water uptake (= cytotoxic edema) and massive glutamate release. Dependent on the tissue’s energy st atus, spreading depolarization can co-occur with different depression or silencing patterns of spontaneous activity. In adequately supplied tissue, spread...
Source: AGE - Category: Geriatrics Source Type: research
ConclusionsThe most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment.ResumenIntroducciónLas hemorragias subaracnoideas corticales (HSAc) tienen numerosas etiologías. No hay estudios prospectivos que indiquen su evolución a largo plazo. El objetivo de este trabajo es describir las característi...
Source: Neurologia - Category: Neurology Source Type: research
The aim of this study was to evaluate the clinical characteristics, risk factors, treatment, and outcomes of pediatric stroke cases. A total of 118 patients diagnosed with arterial ischemic stroke (AIS), hemorrhagic stroke, and sinovenous thrombosis (SVT) between January 2000 and December 2011 were included. Neonatal cases were excluded. Demographic and clinical findings were retrospectively examined from medical records. We identified 118 patients with stroke. The age of the patients ranged from 1 to 215 months (17.92 y), with a mean age of 5.19±5.25 years. AIS accounted for the majority of cases (n=69, 58.5...
Source: Journal of Pediatric Hematology Oncology - Category: Hematology Tags: Original Articles Source Type: research
We report a case of moyamoya disease with epileptic nystagmus. A 23-year-old woman presented with a headache and transient hemiparesis on her left side. Magnetic resonance imaging showed no ischemic or hemorrhagic stroke lesions. Digital subtraction angiography confirmed stenosis of the terminal portion of the right internal carotid artery and the formation of moyamoya vessels on the right side. 123I-N-isopropyl-iodoamphetamine (123I-IMP) single photon emission computed tomography (SPECT) showed decreased uptake in the right basal ganglia, frontal, and parietal regions. After electroencephalography (EEG) and a hyperventila...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
ConclusionPICAD with ischemic stroke is likely under-diagnosed due to the following reasons; 1) patients present with neurological deficits that are non-specific and mild, 2) DSA, which is a gold standard of diagnosing PICAD is not regularly performed in these patients, 3) lack of predisposing factors associated with PICAD in some patients. The mild and non-specific clinical presentation in young adults with PICAD with ischemia probably due to their ability to compensate better given low incidences of other comorbidities. Further investigation regarding the underlying etiology of isolated PICAD, association of proximal PIC...
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
AbstractPurpose of ReviewThis review details the frequency of and ways in which migraine can be both an ischemic stroke/transient ischemic attack mimic (false positive) and chameleon (false negative). We additionally seek to clarify the complex relationships between migraine and cerebrovascular diseases with regard to diagnostic error.Recent FindingsNearly 2% of all patients evaluated emergently for possible stroke have an ultimate diagnosis of migraine; approximately 18% of all stroke mimic patients treated with intravenous thrombolysis have a final diagnosis of migraine. Though the treatment of a patient with migraine wi...
Source: Current Pain and Headache Reports - Category: Neurology Source Type: research
ConclusionCause or consequences of the renal disease, HT must be properly treated in order to reach the recommended targeted blood pressure values. The time required to take charge the hypertensive stroke determines the prognosis. The challenge is to optimize the health care sector to reduce mortality and sequelae.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
Intracranial artery dissection secondary to autosomal dominant polycystic kidney disease is far less common than cerebral aneurysm. A 55-year-old man presented a sudden onset of headache and disturbed consciousness caused by ischemic stroke in the bilateral frontal lobes with minor subarachnoid hemorrhage. The bilateral anterior cerebral arteries were firstly occluded and re-perfused with irregular narrowing and dilation in 3 days after stroke onset, indicating dissection. He was diagnosed with autosomal dominant polycystic kidney disease by abdominal CT findings and by his family history though his renal function was almost normal.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Case Report Source Type: research
ConclusionPICAD with ischemic stroke is likely under-diagnosed due to the following reasons; 1) patients present with neurological deficits that are non-specific and mild, 2) DSA, which is a gold standard of diagnosing PICAD is not regularly performed in these patients, 3) lack of predisposing factors associated with PICAD in some patients. The mild and non-specific clinical presentation in young adults with PICAD with ischemia probably due to their ability to compensate better given low incidences of other comorbidities. Further investigation regarding the underlying etiology of isolated PICAD, association of proximal PIC...
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
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