Reversible cerebral vasoconstriction syndrome presenting with intracranial hemorrhage: a case report and literature review

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IntroductionReversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches with segmental vasoconstriction of the intracranial arteries.RCVS may result in ischemic stroke or intracranial hemorrhage (ICH), but the pathophysiology and data of RCVS-related ICH are not well known [1].The purpose of this case report is to discuss the process of diagnosis of RCVS when ICH is accompanied by severe headache on patients without a specific medical history. Case ReportA 66-year-old female with no specific medical history presented Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by a severe thunderclap headache associated with segmental vasoconstriction of the cerebral arteries.RCVS may result in intracranial hemorrhage (ICH), but the pathophysiology and data of RCVS-related ICH are not well known.The authors report a case of RCVS that presented with intraparenchymal hemorrhage (IPH) and subarachnoid hemorrhage (SAH).A 66-year-old female presented with recurrent thunderclap headache, and her initial consciousness and neurologic status were normal.Brain computed tomography (CT) revealed IPH in the left frontal cortex and SAH in the left Sylvian fissure.CT angiography and digital subtraction angiography showed multiple segmental vasoconstrictions in the M3 segments of the left middle cerebral artery, but intracranial aneurysm or vascular malformation was not observed.After nimodipine infusion and pain control, the headache subsided, and she was discharged without neurologic deficits.Three months after symptom onset, the segmental vasoconstrictions disappeared on cerebral magnetic resonance angiography.Clinicians should be aware of RCVS as a possible cause of non-aneurysmal SAH and IPH in an unusual location.

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