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The Prevalence of Non-Contrast CT Imaging Abnormalities in Reversible Cerebral Vasoconstriction Syndrome: A Systematic Review and Meta-Analysis

Ryan Daniel Gotesman, Naomi Niznick , Brian Dewar, Dean A. Fergusson, Ranjeeta Mallick, Risa Shorr, Michel Shamy, Dar Dowlatshahi

Reversible cerebral vasoconstriction syndrome (RCVS) is a syndrome of recurrent thunderclap headaches and reversible vasoconstriction of the cerebral arteries on neuroimaging within 3 months of onset. Initial non-contrast computed tomography (CT) can reveal abnormalities such as ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage (SAH) can be present in patients with RCVS and may delay diagnosis.

Reversible cerebral vasoconstriction syndrome (RCVS) is a syndrome of recurrent thunderclap headaches and segmental vasoconstriction of cerebral arteries on neuroimaging, which is reversible within 3 months of onset. Accompanying neurologic symptoms, such as focal deficits or seizures, may occur. The diagnosis of RCVS is based on clinical symptoms and characteristic angiographic findings on cerebral vessels imaging. Various diagnostic criteria have been proposed, including the International Classification of Headache Disorders criteria and the RCVS2 score, however the diagnosis of RCVS poses significant challenges due to its variable clinical presentation and overlapping features with other conditions such as primary angiitis of the central nervous system (PACNS) and posterior reversible encephalopathy syndrome

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines [17]. A detailed protocol of the study design and methods was registered (registration number CRD42020190637) and published a priori.

Our electronic database searched yielded 767 studies. With duplicates removed, 722 titles and abstracts were screened, and 148 full-text articles were subsequently reviewed. No additional publications were included after reviewing the reference lists. Twenty articles met inclusion criteria and were included in the meta-analysis.

This meta-analysis provides prevalence estimates for commonly encountered imaging abnormalities on initial non-contrast CT head in patients with RCVS. While it is known that patients with RCVS can have abnormalities on baseline neuroimaging, the frequency of these findings has previously been unclear [6,16,23]. Our synthesis and meta-analysis of the published data reveals an imaging finding prevalence of 24%, 14% and 10% for SAH, ICH and ischemic stroke, respectively, with 31% of patients having any of these findings on baseline CT head.

Citation: Gotesman RD, Niznick N, Dewar B, Fergusson DA, Mallick R, Shorr R, et al. (2024) The prevalence of non-contrast CT imaging abnormalities in reversible cerebral vasoconstriction syndrome: A systematic review and meta-analysis. PLoS ONE 19(3): e0295558.

Editor: Chinh Quoc Luong, Bach Mai Hospital, VIET NAM

Received: August 3, 2023; Accepted: November 24, 2023; Published: March 11, 2024

Copyright: © 2024 Gotesman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Competing interests: The authors declare that there are no conflicts of interest.