Sterk, Brett

Abstract Background and aims Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches and reversible multifocal cerebral arterial narrowing. Although prognosis is generally favorable, a subset of patients develops cerebrovascular complications that may drive long-term disability; this study aims to identify factors associated with these complications. Methods We retrospectively reviewed 348 patients with probable or definite RCVS evaluated at Mayo Clinic between 2010-2023. Diagnostic criteria were adapted from RCVS2 and ICHD-3. The primary outcome was a composite of ischemic stroke, non-aneurysmal subarachnoid hemorrhage, and intracerebral hemorrhage; secondary outcome was poor functional status (modified Rankin Scale ≥2 within one year). Univariable and multivariable logistic regression identified predictors of these outcomes. Results Cerebrovascular complications occurred in 37.6% of patients and were the strongest determinant of poor functional outcome (aOR 5.05, 95% CI 2.04–12.51). On multivariable analysis, older age (aOR per year 1.02, 95% CI 1.00–1.04) and angiographically visible vasoconstriction (aOR 3.14, 95% CI 1.85–5.33) were independently associated with higher risk of cerebrovascular complications, whereas male sex (aOR 0.55, 95% CI 0.30–0.99), thunderclap headache at presentation (aOR 0.30, 95% CI 0.11–0.86), and sexual activity as a trigger (aOR 0.19, 95% CI 0.08–0.42) were associated with lower risk of these complications. Conclusions Cerebrovascular complications are common and strongly predict disability. Angiographic vasoconstriction and older age identify patients at higher risk, whereas thunderclap headache and sexual activity as a trigger mark a more benign phenotype. These findings may guide early risk stratification and help tailored monitoring strategies. Conflict of interest Name of author: nothing to disclose.

Abstract Background Fever and worsening rigidity in Parkinson's disease (PD) may resemble neuroleptic malignant syndrome (NMS). We examined PD patients diagnosed with NMS—regardless of whether diagnostic criteria were used—to establish the clinical characteristics and etiology. Cases Among 15 cases, 40% (6/15) required ICU admission, 27% (4/15) required mechanical ventilation, 80% (12/15) recovered, and 20% (3/15) died. 27% (4/15) had a reduction in carbidopa‐levodopa as the primary trigger, 27% (4/15) had sepsis in addition to concurrent reductions in carbidopa‐levodopa, 7% (1/15) had sepsis alone, 33% (5/15) were exposed to new or increased antidopaminergic drugs, and 7% (1/15) had deep brain stimulator (DBS) malfunction. Literature Review Several terms to describe exacerbation of parkinsonism including NMS‐like state and parkinsonism hyperpyrexia syndrome (PHS) have been proposed over the years but may be restrictive in their definitions and confounders exist. Conclusions Acute parkinsonism dopamine depletion syndrome (APDDS) might be a more encompassing term to describe to an acute exacerbation of preexisting parkinsonism resulting from recent reduction in dopaminergic or other Parkinson's therapy (eg, DBS failure), or exposure to antidopaminergics. Symptoms include increased rigidity, encephalopathy, hyperthermia, or autonomic instability. Sepsis is a frequent confounder and may be associated with concurrent reduction or discontinuation of carbidopa‐levodopa.