Editors' note: Teaching NeuroImages: RCVS causing simultaneous convexity subarachnoid hemorrhage and hemimedullary infarction

Abstract

In their Teaching NeuroImages, authors Selvan and Levine described a patient with reversible cerebral vasoconstriction syndrome (RCVS) presenting with thunderclap headache, normal serum and CSF tests, and convexity subarachnoid hemorrhage and hemimedullary infarct on imaging. Angiography showed a left vertebral artery abnormality and diffuse segmental vasoconstriction. Dr. Ganesh notes that the diagnostic criteria for RCVS require reversal of the angiographic abnormalities within 12 weeks of onset and that follow-up is particularly relevant in this case to assess the progression of the vertebral artery abnormality. Author Selvan relays that subsequent angiography 8 weeks after hospitalization showed no abnormalities and that the patient has remained asymptomatic 2 years after the event. In their Teaching NeuroImages, authors Selvan and Levine described a patient with reversible cerebral vasoconstriction syndrome (RCVS) presenting with thunderclap headache, normal serum and CSF tests, and convexity subarachnoid hemorrhage and hemimedullary infarct on imaging. Angiography showed a left vertebral artery abnormality and diffuse segmental vasoconstriction.