Neurocritical Care

, Volume 7, Issue 3, pp 203–210

Reversible Cerebral Vasoconstriction Syndrome Associated with Subarachnoid Hemorrhage

  • Brian L. Edlow
  • Scott E. Kasner
  • Robert W. Hurst
  • John B. Weigele
  • Joshua M. Levine
Original Paper

DOI: 10.1007/s12028-007-0058-0

Cite this article as:
Edlow, B.L., Kasner, S.E., Hurst, R.W. et al. Neurocrit Care (2007) 7: 203. doi:10.1007/s12028-007-0058-0

Abstract

Introduction

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare vasculopathy of unknown etiology. Ischemic stroke and intracerebral hemorrhage are well-documented sequelae, but subarachnoid hemorrhage is an uncommon complication of RCVS.

Methods and results

We report six cases of RCVS associated with subarachnoid hemorrhage. Two cases occurred in postpartum women, two in women with a history of migraines, one in a woman who recently stopped taking her anti-hypertensive medications, and one in a man after sexual intercourse. All six patients presented with the classic thunderclap headache. Two patients experienced generalized tonic-clonic seizures, and two patients had small ischemic infarcts. Segmental vasoconstriction was demonstrated on cerebral angiography in all six cases. Aneurysmal subarachnoid hemorrhage and other etiologies were excluded. Reversibility of the segmental vasoconstriction was confirmed by follow-up angiography in four patients and by transcranial Doppler sonography in two patients. All six patients had an excellent neurological outcome.

Conclusions

Reversible cerebral vasoconstriction syndrome may be associated with subarachnoid hemorrhage. RCVS should be included in the differential diagnosis of non-aneurysmal subarachnoid hemorrhage.

Keywords

Reversible cerebral vasoconstriction syndromeCall-Fleming syndromeSubarachnoid hemorrhageThunderclap headachePostpartum cerebral angiopathyBenign angiopathy of the central nervous system

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Brian L. Edlow
    • 1
  • Scott E. Kasner
    • 1
  • Robert W. Hurst
    • 3
  • John B. Weigele
    • 3
  • Joshua M. Levine
    • 2
  1. 1.Department of NeurologyUniversity of Pennsylvania Medical CenterPhiladelphiaUSA
  2. 2.Neurocritical Care Program, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical CareUniversity of Pennsylvania Medical CenterPhiladelphiaUSA
  3. 3.Department of Interventional NeuroradiologyUniversity of Pennsylvania Medical CenterPhiladelphiaUSA