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Predictors and outcomes of ischemic stroke in reversible cerebral vasoconstriction syndrome

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Abstract

Introduction

The clinical factors predisposing to ischemic stroke in reversible cerebral vasoconstriction syndrome (RCVS) are unclear. In this observational cross-sectional study, we aimed to evaluate the risk factors and clinical outcomes associated with the development of ischemic stroke in patients with RCVS.

Methods

We utilized the Nationwide Readmissions Database 2016–2017 to identify all hospitalizations with RCVS, with or without acute ischemic stroke. Independent predictors of and clinical outcomes associated with ischemic stroke were analyzed using logistic regression.

Results

Among 1065 hospitalizations for RCVS (mean ± SD age 49.0 ± 16.7 years, female 69.7%), 267 (25.1%) had ischemic stroke. Patients with ischemic stroke were more likely to have hypertension (OR 2.33, 95% CI 1.51–3.60), diabetes (OR 1.81, 95% CI 1.11–2.98), and tobacco use (OR 1.64, 95% CI 1.16–2.33) and were less likely to have a history of migraine (OR 0.56, 95% CI 0.35–0.90). Ischemic stroke was associated with higher odds of cerebral edema (OR 3.15, 95% CI 1.31–7.57) and respiratory failure (OR 2.39, 95% CI 1.28–4.44). Patients with ischemic stroke also had longer hospital stay by a mean duration of 6.7 days, P < 0.001, higher hospital charges by a mean of $72,961, P < 0.001, and a higher likelihood of not being discharged to home (OR 3.57, 95% CI 2.39–5.33). They had higher in-hospital mortality rate; however, the difference was not statistically significant.

Conclusion

Ischemic stroke affects nearly 25% of patients with RCVS and is associated with adverse clinical outcomes. RCVS patients with cerebrovascular risk factors might have a higher predisposition for developing ischemic lesions during the disease process.

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Data availability

The Nationwide Readmissions Database is a publicly available dataset that can be obtained after completion of the HCUP data use agreement.

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Funding

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Authors and Affiliations

  1. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Aayushi Garg

  2. Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Matthew Starr & Marcelo Rocha

  3. Department of Neurology, Neurosurgery, and Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA

    Santiago Ortega-Gutierrez

Authors
  1. Aayushi Garg
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  2. Matthew Starr
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  3. Marcelo Rocha
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  4. Santiago Ortega-Gutierrez
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Contributions

All authors were involved in the conception of the study design. Statistical analysis was performed by AG. The first draft of the manuscript was written by AG and SO-G. All authors were involved in the critical revision of the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Santiago Ortega-Gutierrez.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethics approval

The study was exempt from the Institutional Review Board as we used a publicly available database with deidentified information.

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Garg, A., Starr, M., Rocha, M. et al. Predictors and outcomes of ischemic stroke in reversible cerebral vasoconstriction syndrome. J Neurol 268, 3020–3025 (2021). https://doi.org/10.1007/s00415-021-10456-2

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  • DOI: https://doi.org/10.1007/s00415-021-10456-2

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