Article Figures & Data
Figures
- Fig 1.
DSA of patient 1 illustrates, in the left anterior circulation, diffuse vasoconstriction in peripheral MCA branches before verapamil infusion (arrows in A), which resolves following IA verapamil injection (B). The lower row shows occlusion of the right internal carotid terminus and a filiform caliber of the posterior cerebral artery, which arises from the left posterior communicating artery (C). The caliber increases markedly following verapamil injection, with some residual focal narrowing (arrows in D).
- Fig 2.
MRA of patient 3 on hospital day 1 shows severe vasoconstriction of the basilar artery as well as both ICA terminuses and M1 segments (A). Diffusion-weighted imaging reveals acute ischemia in the left anterior cerebral artery territory (B). Angiogram on hospital day 2 shows severe distal basilar occlusion (C). One hour after infusion of 10 mg of IA verapamil in the proximal left vertebral artery, the spasm is markedly reduced (D). Follow-up MRA, 5 weeks after discharge, demonstrates complete resolution of vasoconstriction (E).
Tables
Criteria 1 Unusual, acute severe headache of progressive or sudden onset, presenting with or without neurologic focal deficit and/or seizure 2 Benign CSF analysis (protein level, <80 mg/dL; leukocyte count, <10/mm3; and normal glucose level) 3 Imaging studies demonstrating 2 different points of vessel narrowing in at least 2 different intracranial arteries 4 Imaging proving absence of intracranial aneurysm/vascular malformation or aneurysmal SAH 5 Reversibility of intracranial vessel narrowing on short-term follow-up evaluation (<12 months) Case Age (yr)/Sex Length of Stay (Days) NIHSS (Admission/Discharge) IA Verapamil (No. of Cycles/Total Amount) Follow-Up Interval (Weeks) Follow-Up Imaging Results or Clinical Examination 1 43/F 19 16/1 5/120 mg 16 Resolution of vasoconstriction 2 43/F 17 0/0 1/30 mg 1 Near-complete resolution of vasoconstriction 3 25/M 14 2/0 2/40 mg, Balloon angioplasty 5 Resolution of vasoconstriction 4 43/F 15 4/2 2/55 mg 12 mRS 1, cognitive delay, NIHSS 0 5 35/F 11 2/0 1/20 mg 1 mRS 0 6 25/F 3 0/0 1/15 mg – Lost to follow-up 7 27/F 6 4/1 1/12.5 mg 1 Resolution of vasoconstriction 8 33/M 4 0/0 1/10 mg – Lost to follow-up 9 69/F 30 10/4 3/60 mg 52 Died from multiple myeloma complications 10 52/F 11 0/0 1/10 mg 6 Resolution of vasoconstriction 11 25/F 21 4/0 6/180 mg – Lost to follow-up Note:—– indicates that no clinical or imaging follow-up was available.
