On the fourth ED visit a CT angiogram (CTA) was completed that demonstrated the characteristic “string of beads” appearance of the middle cerebral artery (MCA) diagnostic of RCVS. RCVS is characterized by recurrent acute severe headaches which may be associated with seizures and focal neurological … He was subsequently treated with supportive management and made an uneventful recovery. Though these are also often seen in migraines, RCVS is distinct in that the presenting headache is excruciating and abrupt in nature [6]. A similar syndrome has attracted many different names, depending on whether patients present to … Please note that Cureus is not responsible for any content or activities contained within our partner or affiliate websites. While a rarely made diagnosis in emergency medicine practice, RCVS may be as … However, the causal direction of the relationship is difficult to prove. Anything above 5 should be considered above average. Frustratingly, the presentation of RCVS is often clouded by a less-than-clear diagnosis and … The patient denied fever, chills, and any neurological deficits. RCVS is a headache syndrome classically described as thunderclap with associated diffuse, multifocal narrowing of cerebral arteries. Though GDPR was built to protect Europeans, it will affect organizations around the world doing business in the EU. The American Heart Association is qualified 501(c)(3) tax-exempt Literature review was done via PubMed, without date limitations, with the search terms: reversible cerebral vasoconstriction, RCVS, Call-Fleming syndrome, TCH, benign angiopathy of the central nervous system, postpartum angiopathy, migrainous vasospasm, migraine angiitis, drug-induced cerebral arteritis or angiopathy, and sexual headache. See Table 1 for a detailed timeline. Neurology was consulted to assist in patient management. In the ED, patients with severe headaches are evaluated for red flags, risk factors, and any symptoms that may support the diagnosis of a serious cause of headache [i.e., subarachnoid hemorrhage (SAH), meningitis]. This large series (for a fairly rare condition) allowed the authors not only to describe the patterns of bleeding but also to investigate the risk factors for hemorrhage in RCVS. It is essential for the clinicians involved in the evaluation of patients with CNS vasculitis to be aware of its mimics especially RCVS. Roberts A, Sowers N (May 31, 2020) A Case of Reversible Cerebral Vasoconstriction Syndrome in a Healthy Adult Male. The authors argue that the pattern of subarachnoid blood in their cohort (unilateral or bilateral focal cortical) is unlikely to cause multifocal vasospasm. This site uses cookies. In the majority of cases, there exists an identifiable trigger such as exertion, coughing, defecation, or the use of vasoactive substances [3-4]. A lumbar puncture performed on his third presentation the following day (seven days since symptom onset) was unremarkable. Multiple etiologies for RCVS are suggested by the many and varied associations, including sympathomimetic, serotonergic, or other drugs, pregnancy, and the puerperium,2 although no obvious cause can be found in approximately one-half of cases. However, before treatment for RCVS can be confidently recommended, trials targeting those at highest risk for poor outcome with rational therapeutic approaches are needed; however, such studies must await a clearer understanding of the underlying mechanisms and prognostic indicators. High ratings should be reserved for work that is truly groundbreaking in its respective field. How often is thunderclap headache caused by the reversible cerebral vasoconstriction syndrome? This work was undertaken at UCLH/UCL, which received a proportion of funding from the UK Department of Health’s National Institute for Health Research Biomedical Research Centers funding scheme (UCLH/UCL Comprehensive Biomedical Research Trust). "Never doubt that a small group of thoughtful, committed citizens can change the world. RCVS typically presents as a sudden onset, excruciating headache that may be associated with nausea, vomiting, … Because of the similarities with postsubarachnoid hemorrhage-related vasospasm, calcium channel blockers are used in some centers;11 high-dose glucocorticoids are sometimes recommended12 because of radiological similarities with vasculitic disorders and experimental evidence that glucocorticoids reduce vasoconstriction. While a rarely made diagnosis in emergency medicine practice, RCVS may be as common as subarachnoid hemorrhage (SAH). Roberts A, Sowers N (May 31, 2020) A Case of Reversible Cerebral Vasoconstriction Syndrome in a Healthy Adult Male. There is currently no treatment shown to improve outcome in RCVS. Although this patient had some historical features that are documented to be associated with RCVS (e.g., vasoactive substance use, migraine), it is not clear whether they were temporally related to the headache. The CT scan showed no intracranial hemorrhage, edema, mass, or signs of herniation. Reviewing with Cureus is easy, fast and hassle-free!

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