Reversible cerebral vasoconstriction syndrome associated with subarachnoid hemorrhage.
BACKGROUND
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.


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.
Edlow
Brian L
BL
Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
Kasner
Scott E
SE
Hurst
Robert W
RW
Weigele
John B
JB
Levine
Joshua M
JM
D000328:Adult; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology; D011644:Puerperal Disorders / Q000209:etiology; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013577:Syndrome; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy