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KMID : 1150320210170020076
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Journal of Korean Society of Geriatric Neurosurgery
2021 Volume.17 No. 2 p.76 ~ p.79
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Reversible cerebral vasoconstriction syndrome presenting with intracranial hemorrhage: a case report and literature review
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Choi Tae-Won
Shin Hee-Sup
Lee Seung-Hwan
Koh Jun-Seok
Ko Hak-Cheol
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Abstract
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Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by a severe thunderclap headache associated with segmental vasoconstriction of the cerebral arteries. RCVS may result in intracranial hemorrhage (ICH), but the pathophysiology and data of RCVS-related ICH are not well known. The authors report a case of RCVS that presented with intraparenchymal hemorrhage (IPH) and subarachnoid hemorrhage (SAH). A 66-year-old female presented with recurrent thunderclap headache, and her initial consciousness and neurologic status were normal. Brain computed tomography (CT) revealed IPH in the left frontal cortex and SAH in the left Sylvian fissure. CT angiography and digital subtraction angiography showed multiple segmental vasoconstrictions in the M3 segments of the left middle cerebral artery, but intracranial aneurysm or vascular malformation was not observed. After nimodipine infusion and pain control, the headache subsided, and she was discharged without neurologic deficits. Three months after symptom onset, the segmental vasoconstrictions disappeared on cerebral magnetic resonance angiography. Clinicians should be aware of RCVS as a possible cause of non-aneurysmal SAH and IPH in an unusual location.
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KEYWORD
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Vasoconstriction, Subarachnoid hemorrhage, Intracranial hemorrhages, Headache
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