Diagnostic angiogram on day 8 after symptom onset via right transfemoral access (4F).
Images of the right ACC, ACI, ACE and bilateral VA are shown.
Right internal carotid artery: Cervical segment shows 'string of beads' sign. Possible FMD (fibromuscular dysplasia).
Right external carotid artery: Diffuse caliber abnormalities.
Right vertebral artery: Caliber abnormalities in V3, V4, basilar artery and PCA. The basilar tip appears bigger than the rest of the basilar artery. Left vertebral artery: Smaller than the right VA, V3 caliber irregularity.
Because of diffuse caliber irregularities in MCA and VA territory and recent SAH we suspected RCVS.
After intraarterial local injection of calcium antagonist nimodipine (1 mg over 10 minutes) reversibility of the caliber changes is demonstrated, normalized diameter of basilar artery.
This raises the probability for RCVS.
No demonstration of aneurysms or vascular malformations as cause for the subarachnoid haemorrhage.