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Case ReportCase Report

Reversible Cerebral Vasoconstriction Syndrome: Treatment with Combined Intra-Arterial Verapamil Infusion and Intracranial Angioplasty

H. Farid, J.K. Tatum, C. Wong, V.V. Halbach and S.W. Hetts
American Journal of Neuroradiology November 2011, 32 (10) E184-E187; DOI: https://doi.org/10.3174/ajnr.A2341
H. Farid
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J.K. Tatum
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C. Wong
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V.V. Halbach
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    Fig 1.

    A, On day 9 of illness, MRA of the circle of Willis demonstrates normal caliber of the ICAs, MCAs, ACAs, and vertebrobasilar system. B−D, At the same time, FLAIR shows bilateral parieto-occipital white matter edema, leading to an initial diagnosis of PRES. E−H, FLAIR MR imaging on illness day 19 shows progressive edema involving the occipital, parietal, and paramedian posterior frontal lobes. I−P, Diffusion-weighted imaging (I−L) and concomitant apparent diffusion coefficient maps (M−P) on illness day 19 confirm extensive infarction in the occipital, parietal, and paramedian posterior frontal lobes, corresponding to almost the entire extent of FLAIR abnormality.

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    Fig 2.

    A, Before endovascular treatment, digital subtraction angiography on illness day 19 demonstrates marked narrowing of the basilar artery (measuring 1.1 mm in diameter) and proximal PCAs, with beaded irregular areas of narrowing and dilation in the distal PCAs. B, Following intra-arterial verapamil infusion, marked improvement is noted in the caliber of the basilar artery (2.2 mm) as well as the proximal PCAs. C, After PTA of the basilar artery, basilar artery caliber is further improved (3.1 mm). D, Repeat digital subtraction angiography on illness day 32 demonstrates stable basilar caliber (3.0 mm), though subsequent to further intra-arterial verapamil administration, further basilar artery dilation was observed (to 3.7 mm, not shown).

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American Journal of Neuroradiology: 32 (10)
American Journal of Neuroradiology
Vol. 32, Issue 10
1 Nov 2011
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H. Farid, J.K. Tatum, C. Wong, V.V. Halbach, S.W. Hetts
Reversible Cerebral Vasoconstriction Syndrome: Treatment with Combined Intra-Arterial Verapamil Infusion and Intracranial Angioplasty
American Journal of Neuroradiology Nov 2011, 32 (10) E184-E187; DOI: 10.3174/ajnr.A2341

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Reversible Cerebral Vasoconstriction Syndrome: Treatment with Combined Intra-Arterial Verapamil Infusion and Intracranial Angioplasty
H. Farid, J.K. Tatum, C. Wong, V.V. Halbach, S.W. Hetts
American Journal of Neuroradiology Nov 2011, 32 (10) E184-E187; DOI: 10.3174/ajnr.A2341
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  • Quantifying Intra-Arterial Verapamil Response as a Diagnostic Tool for Reversible Cerebral Vasoconstriction Syndrome
  • Intra-Arterial Verapamil Treatment in Oral Therapy-Refractory Reversible Cerebral Vasoconstriction Syndrome
  • Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome
  • Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis
  • Multimodal Imaging of Reversible Cerebral Vasoconstriction Syndrome: A Series of 6 Cases
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