Reversible Cerebrovascular Vasoconstriction Syndrome Clinical Trial
Official title:
Non Invasive Assessment of Morphological and Functional Retinal Patterns in Reversible Cerebral Vasoconstriction Syndrome Using Transorbital Echotomography Doppler, Retinography and Retinal Vessel Analyser
Reversible cerebral vasoconstriction syndrome (RCVS) is a clinico radiological entity
characterized by severe headaches (associated or not with neurological complications) during
one to 3 weeks, associated with a characteristic 'string and beads' appearance on cerebral
arteries, which resolves spontaneously in 3 months. The pathway is unknown. At early stage
of the disease (at the first medical consultation) cerebral arterial abnormalities which are
necessary for diagnosis are identified in only 20% of patients (brain magnetic resonance
imagery (MRI) ,CT scan angiography), appearing with a delay on 2th or 3rd week after the
first severe headache..
Retinal artery network is considered to be a window on brain microvasculature by sharing the
same embryologic origin and physiopathology. A retinal arteriolar examination at early stage
of RCVS could provide non invasively early clue to confirm diagnosis by identifying
anatomical change and /or functional abnormalities at the microvascular level, whereas large
cerebral artery abnormalities are still normal.
Reversible cerebral vasoconstriction syndrome (RCVS) is a clinico radiological entity
characterized by severe headaches (associated or not with neurological complications) during
one to 3 weeks, associated with a characteristic 'string and beads' appearance on cerebral
arteries, which resolves spontaneously in 3 months.
The pathway is unknown. One strong hypothesis is that RCVS is a vasospasm and-vasodilatation
disorder starting from small distal cerebral arteries progressing toward to medium sized and
large sized cerebral arteries, and disappearing in 3 months.
At early stage of the disease (generally at the first medical consultation round 7 days
after the first headache), arterial caliber anomalies cannot be identified on usual
investigation (brain MRI, angioscan) in most of the case (80%). They are appearing secondary
on repeated angiogram around the 2nd week or 3rd week, permitting to confirm the diagnosis,
but with delay. Currently, small cerebral vessel arteries can't be studied directly .
Retinal artery network is easy to study. It is considered to be a window on brain
microvasculature by sharing the same embryologic origin and physiopathology. The
investigators thus hypothesized that retinal arteriolar examination a early stage of RCVS
could provide non invasively early clue to confirm diagnosis by identifying anatomical
change and /or functional abnormalities at the microvascular level, whereas large cerebral
artery abnormalities are still normal.
Hypothesis Arteriolar caliber and vasoreactivity abnormalities at the retinal microvascular
level could be an early, non invasive and sensitive diagnostic marker of the RCVS at the
first medical consultation in emergency.
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