Abstract WP207: Current Incidence, Epidemiological and Clinical Characteristics of Reversible Cerebral Vasoconstriction in the United States

Abstract

Background: There is a paucity of contemporary data on incidence, epidemiological and clinical characteristics of reversible cerebral vasoconstriction syndrome (RCVS) in the United States. This study aimed to address these gaps in knowledge. Method: All patients with a primary and secondary diagnosis of RCVS were identified from the 2016 National Readmissions Database (n=1,152) using International Classification of Disease-10 code I67.841. Unique patients were defined using the NRD’s unique patient identifier. Overall and sex-specific incidences of RCVS were computed by combining RCVS counts with the 2016 US census population data. RCVS comorbidities, complications and outcome were presented using descriptive statistics. Result: The overall incidence of RCVS per million population (SE) was 4.62 (0.14) but the incidence in women 7.20 (0.24) was nearly four times that of men 1.91(0.13). Mean age (SE) was 47.2(0.9) but up to 87% of patients were < 65 years. Most common comorbidities seen in these patients were hypertension 51.7%, diabetes 19.3%, hyperlipidemia 25.4%, inflammatory disorders 20.7%, pregnancy 7.6%, postpartum 8.6%, and preeclampsia-eclampsia conditions 4.4%. Illicit drug abuse was nicotine 24.2%, cannabis 7.7%, alcohol 3.1% and cocaine 1.1%. A cerebral angiogram was documented in 25.1% of cases, and spinal tap in 16.3%. Most common associated complications included subarachnoid hemorrhage 21.3%, migraine 18.6%, ischemic stroke 14%, intracerebral hemorrhage 8.6%, epilepsy 9.3%, brain edema 7%, PRES 6.7%, and thunderclap headache 5.9%. Majority of patients were admitted to urban 88% and larger bedside hospital 60%. Majority of patients have private insurance 46% followed by Medicaid 24% and Medicare 23%. Average inpatient cost ($) was 25,135 ± 1,690.9 and length of Stay (Days) was 8.0 ± 0.4. Excellent outcomes were reported including 71% discharge to home, 14% of patients were discharged to a facility and in-hospital mortality was rare (0.4%). Conclusion: RCVS is still rare in the US but the current incidence in women is almost four times that of men. Subarachnoid hemorrhage appears to be the most common documented comorbidity but in-hospital mortality is rare.