Gender and hormonal influences in reversible cerebral vasoconstriction syndrome

Introduction The reversible cerebral vasoconstriction syndromes, including postpartum angiopathy, have been characterized over the last decade. Women are predominantly affected. Some studies suggest that postpartum angiopathy carries a worse prognosis. Patients and methods We compared the clinical, neuroimaging, and angiographic features of 36 men, 110 non-pregnant women and 16 postpartum women included in our single-center cohort of patients with reversible cerebral vasoconstriction syndromes encountered from 1998 to 2016. Results As compared to men, non-pregnant women were older (48 ± 11 vs. 34 ± 13 years, p < 0.001), had more underlying migraine (49% vs. 19%, p = 0.002), depression (53% vs. 14%, p < 0.001) and serotonergic antidepressant use (45% vs. 11%, p < 0.001), developed more clinical worsening (18% vs. 3%, p = 0.022), more infarcts (39% vs. 20%, p = 0.031) and worse angiographic severity scores (23 ± 14 vs. 10.9 ± 10.3, p < 0.001), but had similar discharge outcomes (modified Rankin scale scores 0–3, 90% vs. 91%, p = 0.768). Sexual activity was an important trigger in men (22% vs. 4%, p = 0.002). As compared to non-pregnant women, postpartum angiopathy patients were younger (33 ± 6 years, p < 0.001) and had less vasoconstrictive drug exposure (25% vs. 67%, p = 0.002) but showed similar clinical, radiological and angiographic findings and similar discharge outcomes (modified Rankin scale scores 0–3 in 94%, p = 0.633). There were no significant differences between pre- and post-menopausal women, or those with and without hysterectomy. Discussion/Conclusion The observed gender differences in reversible cerebral vasoconstriction syndromes may result from hormonal or non-hormonal factors. Hormonal imbalances may trigger reversible cerebral vasoconstriction syndromes. Given the absence of significant differences in the female subgroups, hormonal factors do not appear to significantly affect the course or outcome of reversible cerebral vasoconstriction syndromes.

[1]  A. Singhal,et al.  Long-term outcomes after reversible cerebral vasoconstriction syndrome , 2016, Cephalalgia : an international journal of headache.

[2]  C. Chi,et al.  Reduced circulating endothelial progenitor cells in reversible cerebral vasoconstriction syndrome , 2014, The Journal of Headache and Pain.

[3]  A. Singhal,et al.  Reversible cerebral vasoconstriction syndrome. , 2014, JAMA neurology.

[4]  Yen-Feng Wang,et al.  Oxidative stress and increased formation of vasoconstricting F2-isoprostanes in patients with reversible cerebral vasoconstriction syndrome. , 2013, Free radical biology & medicine.

[5]  E. Wijdicks,et al.  Variable Presentations of Postpartum Angiopathy , 2012, Stroke.

[6]  Shih-Pin Chen,et al.  Hyperintense vessels on flair imaging in reversible cerebral vasoconstriction syndrome , 2012, Cephalalgia : an international journal of headache.

[7]  J. Parisi,et al.  Fulminant postpartum cerebral vasoconstriction syndrome. , 2012, Archives of neurology.

[8]  M. Gizzi,et al.  Reversible cerebral vasoconstriction syndrome in a 35-year-old woman following hysterectomy and bilateral salpingo-oophorectomy , 2011, Journal of NeuroInterventional Surgery.

[9]  Shih-Pin Chen,et al.  Reversible cerebral vasoconstriction syndrome: current and future perspectives , 2011, Expert review of neurotherapeutics.

[10]  A. Singhal,et al.  Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. , 2011, Archives of neurology.

[11]  A. Straube,et al.  Reversible cerebral vasoconstriction syndrome associated with hormone therapy for intrauterine insemination , 2010, Cephalalgia : an international journal of headache.

[12]  H. Leung,et al.  Reversible Cerebral Vasoconstriction Syndrome with Posterior Leucoencephalopathy after Oral Contraceptive Pills , 2010, Cephalalgia : an international journal of headache.

[13]  B. Shia,et al.  Magnetic resonance angiography in reversible cerebral vasoconstriction syndromes , 2009, Annals of neurology.

[14]  A. Ducros,et al.  Reversible cerebral vasoconstriction syndrome , 2009, Practical Neurology.

[15]  P. Schaefer,et al.  Case records of the Massachusetts General Hospital. Case 8-2009. A 36-year-old woman with headache, hypertension, and seizure 2 weeks post partum. , 2009, The New England journal of medicine.

[16]  W. Bartynski.  Posterior Reversible Encephalopathy Syndrome, Part 1: Fundamental Imaging and Clinical Features , 2008, American Journal of Neuroradiology.

[17]  R. Porcher,et al.  The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. , 2007, Brain : a journal of neurology.

[18]  A. Singhal,et al.  Narrative Review: Reversible Cerebral Vasoconstriction Syndromes , 2007, Annals of Internal Medicine.

[19]  J. Fuh,et al.  Recurrent primary thunderclap headache and benign CNS angiopathy , 2006, Neurology.

[20]  E. Gizewski,et al.  Serial neurochemical measurement of cerebrospinal fluid during the human sexual response cycle , 2006, The European journal of neuroscience.

[21]  D. Pelligrino,et al.  Influence of sex steroid hormones on cerebrovascular function. , 2006, Journal of applied physiology.

[22]  A. Singhal,et al.  Postpartum angiopathy and other cerebral vasoconstriction syndromes , 2005, Neurocritical care.

[23]  M. Bousser.  Estrogens, Migraine, and Stroke , 2004, Stroke.

[24]  A. Singhal.  Postpartum angiopathy with reversible posterior leukoencephalopathy. , 2004, Archives of neurology.

[25]  S. Evers,et al.  Headache associated with sexual activity , 2003, Neurology.

[26]  C. Oppenheim,et al.  Evaluation of Hyperintense Vessels on FLAIR MRI for the Diagnosis of Multiple Intracerebral Arterial Stenoses , 2003, Stroke.

[27]  R. Victor,et al.  Transdermal Estrogen Replacement Therapy Decreases Sympathetic Activity in Postmenopausal Women , 2001, Circulation.

[28]  G. Jennings,et al.  Estrogen supplementation decreases norepinephrine-induced vasoconstriction and total body norepinephrine spillover in perimenopausal women. , 1997, Hypertension.