Journal
BRAIN SCIENCES
Volume 11, Issue 5, Pages -Publisher
MDPI
DOI: 10.3390/brainsci11050601
Keywords
reversible cerebral vasoconstriction syndrome; endothelin-1; antioxidants; vasoconstriction; nitric oxide; vasodilation; brain; magnetic resonance angiography
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Funding
- Basic Science Research Program through the National Research Foundation of Korea - Ministry of Science and ICT [NRF-2018R1C1B5086320]
- Kangdong Sacred Heart Hospital Fund [2020-07]
- Hallym University Research Fund, 2020 [HURF-2020-37]
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RCVS is a rare disease characterized by reversible multifocal stenosis of cerebral arteries, with unclear pathomechanisms. This reported case linked RCVS to the levonorgestrel-releasing IUS, causing thunderclap headache and multiple arterial stenosis. The potential role of levonorgestrel in vasoconstriction and endothelin-1 elevation may shed light on the mechanisms of RCVS.
Reversible cerebral vasoconstriction syndromes (RCVS) is a rare disease that is characterized by reversible multifocal stenosis of the cerebral arteries with various clinical manifestations. Though the pathomechanism of RCVS was unclear, we reported RCVS related to the levonorgestrel-releasing intrauterine system (IUS). A previous healthy 36-year-old woman had thunderclap headache after implanting the levonorgestrel-releasing IUS a year ago. In the serial angiography, we initially found left vertebra artery (VA), and then additionally new stenosis of both anterior cerebral arteries and middle cerebral arteries (MCA). Bilateral MCA stenosis improved but developed stenosis of right VA after a week. The mean flow velocities of both MCA increased in the first transcranial doppler (TCD), but normalized in the follow up TCD. Levonorgestrel might act as the vasoconstrictitve factor that increased the level of endothelin-1, diminished the release of NO and raised oxidative low-density lipoprotein (LDL). Although the exact pathological mechanisms for RCVS were not yet elucidated, this case might help clinicians understand the mechanisms of RCVS.
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