Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is an underdiagnosed cause of convexal subarachnoid hemorrhage, characterized by thunderclap headache associated with focal and segmental intracranial vasoconstriction. It can appear complications such as intracerebral hemorrhage, seizures, posterior reversible leukoencephalopathy, or ischemic stroke. Our objective is to present the case of a 51-year-old woman with an RCVS diagnosis, who had a normal digital subtraction angiography at the illness onset. We highlight the high diagnostic value of thunderclap headache and convexal subarachnoid hemorrhage. We also highlight the importance of repeating the angiographic studies in the second week when there is strong diagnostic suspicion.
Highlights
Reversible cerebral vasoconstriction syndrome (RCVS) is a unified term proposed to describe an entity characterized by thunderclap headache associated with focal segmental vasoconstriction that resolves spontaneously within three months [1]
We present the case of a young woman with normal digital subtraction angiography (DSA) at the onset of her disease, but the characteristics of the thunderclap headache and the early finding of convexal subarachnoid hemorrhage allowed us to reaffirm the possibility of RCVS
There was a recurrence of thunderclap headache, the magnetic resonance angiography (MRA) showed segmental stenosis of the intracranial arteries, and the diagnosis of RCVS was established
Summary
Reversible cerebral vasoconstriction syndrome (RCVS) is a unified term proposed to describe an entity characterized by thunderclap headache associated with focal segmental vasoconstriction that resolves spontaneously within three months [1]. We present the case of a young woman with normal digital subtraction angiography (DSA) at the onset of her disease, but the characteristics of the thunderclap headache and the early finding of convexal subarachnoid hemorrhage (cSAH) allowed us to reaffirm the possibility of RCVS. A 51-year-old female with no significant medical history, who seven days before admission presented with a mild headache of recent onset. Two days before her admission, while she was exercising, she had a sudden, predominantly frontal, throbbing, holocranial headache, which in a matter of seconds reached an intensity of 9/10, associated with vomiting. During the two days, she had two similar episodes of headache associated with vomiting, after defecation.
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