Factors associated with complications in reversible cerebral vasoconstriction syndrome: A seven-year study at a comprehensive stroke center.

OBJECTIVE

A small subset of patients with reversible cerebral vasoconstriction syndrome (RCVS) experience serious complications and poor outcomes. The objective of this study was to identify demographic and clinical factors associated with complications in RCVS.

METHODS

We conducted a retrospective cohort study of adults (≥18 years) admitted with RCVS to a comprehensive stroke center between 2016 and 2023. Patient characteristics, serious complications (subarachnoid hemorrhage [SAH], intracerebral hemorrhage, ischemic stroke, reversible cerebral edema, or seizure), and discharge outcomes were analyzed. Patients were stratified by sex. Univariate logistic regression assessed associations between clinical variables and discharge disposition.

RESULTS

Among 35 patients (75 % female, median age 44 years), 57 % experienced a serious complication, most commonly SAH (34 %) and ischemic stroke (29 %). Patients with complications were more often female (90 % vs. 53 %, p = 0.02), had longer hospital stays (median 9 vs. 3 days, p = 0.005), received more verapamil (p = 0.005), and were less frequently discharged home (65 % vs. 100 %, p = 0.01). Females had higher rates of complications than males (69 % vs. 22 %, p = 0.02), especially ischemic stroke (38 % vs. 0 %, p = 0.04). Discharge home was more likely in younger patients and those with lower rates of hyperlipidemia (HLD), fewer focal neurologic deficits, and less steroid use. HLD (OR 20.25, p = 0.02), steroid use (OR 11.11, p = 0.02), and focal deficits (OR 11.50, p = 0.01) predicted discharge to a facility.

CONCLUSION

Despite overall positive clinical outcomes, a higher rate of serious complications in women, particularly ischemic strokes, warrants further investigation.