COVID-19 Associated Reversible Cerebral Vasoconstriction Syndrome Successfully Treated with Nimodipine and Aspirin

J Stroke Cerebrovasc Dis. 2021 Jul;30(7):105822. doi: 10.1016/j.jstrokecerebrovasdis.2021.105822. Epub 2021 Apr 12.

Abstract

There have been limited cases linking SARS-CoV-2 infection with the development of reversible cerebral vasoconstriction syndrome (RCVS). We hereby report a rare case of RCVS in the setting of mild SARS-CoV-2 respiratory infection successfully treated with nimodipine and aspirin. SARS-CoV-2 attacks the ACE2-receptors, which are expressed in various body organs including the lungs, kidneys, and blood vessels. Vasoconstriction can result from down-regulation of the ACE2-receptors that can lead to sympathetic hypertonia of the cerebral blood vessel walls and/or over-activation of the renin-angiotensin axis.

Keywords: Aspirin; COVID-19; Nimodipine; Posterior reversible encephalopathy syndrome; Reversible cerebral vasoconstriction syndrome; SARS-CoV-2.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aspirin / therapeutic use*
  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / drug effects*
  • Cerebral Arteries / physiopathology
  • Female
  • Humans
  • Nimodipine / therapeutic use*
  • Syndrome
  • Treatment Outcome
  • Vasoconstriction / drug effects*
  • Vasodilator Agents / therapeutic use*
  • Vasospasm, Intracranial / diagnostic imaging
  • Vasospasm, Intracranial / drug therapy*
  • Vasospasm, Intracranial / etiology
  • Vasospasm, Intracranial / physiopathology

Substances

  • Vasodilator Agents
  • Nimodipine
  • Aspirin