Chen SP, et al. - In patients with reversible cerebral vasoconstriction syndrome (RCVS), researchers examined the spatiotemporal distribution and pathomechanisms of white matter hyperintense lesions (WMHs). In patients with RCVS, white matter hyperintensities had a dynamic temporal evolution that parallels disease severity. Practitioners taking care of subjects with RCVS should know that finding partially reversible WMHs deserves attention. Results of this study suggested that white matter hyperintensities in RCVS might be attributed, at least somewhat, to regional hypoperfusion and impaired dampening capacity to central pulsatile flow.

Methods

• From January 2010 through December 2012, patients with RCVS over a 3-year period were prospectively recruited from the headache center or Emergency Department of Taipei Veterans General Hospital, Taipei, Taiwan, a 2947-bed national medical center.
• Eighty-five subjects with RCVS were approached, of whom 4 declined to partook, 5 declined follow-up scans, 6 were lost to follow-up, and 5 had suboptimal images.
• For this investigation, patients received serial isotropic 3-dimension fluid-attenuated inversion recovery sequence imaging (1-mm slice thickness) with a 3-T magnetic resonance imaging machine, as well as transcranial and extracranial color-coded sonography on registration and during follow-ups (at 1 and 2 months, with variations adapting to clinical condition).
• From January 2015 to May 2017, data were analyzed.
• To segment WMHs automatically, the fluid-attenuated inversion recovery lesion segmentation toolbox was used.
• They classified WMHs as periventricular or deep and were segmented into 13 anatomical locations.
• The neuroimaging researchers who implemented the program were blinded to clinical information.
• Vascular parameters, including the Lindegaard index (vasoconstriction severity), pulsatility index, and resistance index of the internal carotid artery, were independently gathered for correlation.

Results

• As per data, 65 patients with RCVS completed the study and had a total of 162 magnetic resonance imaging examinations.
• Out of 65 included patients, 58 (89%) were women, and the mean (SD) age was 50.1 (8.9) years.
• It was noted that the total mean (SD) WMH load peaked at 3.2 (4.4) cm³ in the third week postonset and fell to 0.8 (0.6) cm³ in the fourth week.
• They observed that white matter hyperintensities were predominantly frontal and periventricular.
• A strong association was found between white matter hyperintensity load and Lindegaard index during the second week of the disease course (r = 0.908; P < .001) and also related to the pulsatility index and resistance index of the internal carotid artery.