Reversible cerebral vasoconstriction syndrome (RCVS) with associated convexity subarachnoid hemorrhage, nimodipine-reversibility

Discussion:

In a Patient with sudden onset of headaches and hypesthesia the same day CT shows a nontraumatic right high frontal subarachnoid hemorrhage (convexity SAH with sulcal localization). CT angiogram shows no aneurysm.

The patient one week later is referred to a neurovascular center. The cathether angiogram 8 days after symptom onset shows no aneurysm or vascular malformations, but diffuse caliber irregularities involving the posterior circulation. This means the vascular changes are seen in a different location than the hemorrhage. Reversibility after intraarterial calcium antagonist nimodipine (1mg, 10min). 

Possible RCVS (reversible cerebral vasoconstriction syndrome) with associated SAH. The time interval since symptom onset (8 days) means SAH-associated cerebral vasospasm are a differential diagnosis, but the localization of vascular abnormalities in the posterior circulation while there is frontal SAH raise suspicion pof RCVS. Liquor examination showed WBC, glucose or protein. 

No history of drug use, migraine, prior hemorrhage. A follow-up angiogram for the patient is to be schedulred (rule out aneurysm, malformations again). Follow-up liquor examination, follow-up duplex ultrasound scheduled. The patient received nimodipine orally for the following 8 weeks.

Angiogram courtesy of Prof. R. Chapot and Dr. E. Celik (Alfried Krupp Krankenhaus Essen, Germany), CT head courtesy of Prof. M. Dihné (St. Lukas Klinik Solingen, Germany).

    Create a new playlist
Loading...