Acute headache at emergency department: reversible cerebral vasoconstriction syndrome complicated by subarachnoid haemorrhage and cerebral infarction

Case Reports in Emergency Medicine
M YgerY Samson

Abstract

Introduction. Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH) and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome. Case Report. A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache. Conclusion. Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications wer...Continue Reading

References

Aug 2, 2001·The Medical Clinics of North America·T N WardJ M Phillips
Jun 20, 2006·Lancet Neurology·Todd J SchwedtDavid W Dodick
Dec 24, 2010·Therapeutic Advances in Neurological Disorders·Shih-Pin ChenShuu-Jiun Wang
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Sep 22, 2012·Lancet Neurology·Anne Ducros

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Citations

Sep 12, 2013·Clinical Neurology and Neurosurgery·Th RobertA Uské

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