A pediatric case of reversible segmental cerebral vasoconstriction.
BACKGROUND
Reversible segmental cerebral vasoconstriction (RSCV) is a recognizable clinical and radiographic syndrome consisting of thunderclap headache with or without focal neurological symptoms combined with reversible segmental vasoconstriction of proximal cerebral blood vessels.


METHODS
We report a case of reversible segmental cerebral vasoconstriction in a child.


RESULTS
A healthy 13-year-old boy experienced the sudden onset of a severe, diffuse headache upon surfacing from a deep dive in a swimming pool. Severity was maximal at the onset and improved over several hours. The same headache recurred three times over the next four days and a low baseline headache persisted throughout. Vomiting occurred once and mild photo/osmophobia were reported but throbbing, aura, or autonomic symptoms were absent. Focal neurological signs or symptoms were absent and he denied previous history of headaches, medications, drugs, or trauma. Two normal CT scans were performed within hours of separate headaches. Cerebrospinal fluid study on day 5 was bloody with no xanthochromia. MRI/MRA/MRV of the brain and vasculitic work-up were normal. Cerebral angiography on day 6 demonstrated smooth narrowing of multiple proximal cerebral vessels including supraclinoid internal carotid artery (ICA), M1, and A1 on the right and M1 on the left. By ten days, the patient's headaches had resolved and repeat angiography was normal.


CONCLUSIONS
RSCV should be considered in a child with thunderclap headache.
Kirton
Adam
A
Department of Pediatrics, Division of Pediatric Neurology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
Diggle
John
J
Hu
William
W
Wirrell
Elaine
E
D000293:Adolescent; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D004242:Diving / Q000009:adverse effects; D020773:Headache Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D051270:Headache Disorders, Primary / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D006874:Hydrostatic Pressure / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014661:Vasoconstriction / Q000502:physiology*; D020301:Vasospasm, Intracranial / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology