title: Possible overlap between reversible cerebral vasoconstriction syndrome and symptomatic vasospasm after aneurysmal subarachnoid hemorrhage.
abstract: A 34-year-old woman with a previous history of severe headache ("thunderclap") was admitted with a diagnosis of aneurysmal subarachnoid hemorrhage (SAH). The patient developed symptomatic vasospasm on day 5 that resolved rapidly after having increased arterial blood pressure. She experienced also short-lasting excruciating headache. On day 12, while velocities had normalised, as revealed by transcranial Doppler (TCD), for more than 48 h, she developed aphasia and right hemiplegia associated with diffuse segmental vasospasm on the left middle cerebral artery. Intra-arterial infusion of vasodilatory agents was required. Recurrence of symptomatic vasospasm was noted on day 25, with a great number of territories involved as shown in the cerebral angiogram. A second intra-arterial treatment was needed. The patient complained of multiple episodes of extremely severe headache ("thunderclap"), with also transient dysarthria and hemiparesia on day 30. She was discharged on day 38 after full recovery. The clinical and TCD/radiological findings were consistent with a reversible cerebral vasoconstriction syndrome overlapping SAH related symptomatic vasospasm.
authors.affiliation: Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Avenue Hippocrate, 10, Brussels 1200, Belgium.
authors.forename: Patrice
authors.initials: P
authors.lastname: Forget
authors.forename: Pierre
authors.initials: P
authors.lastname: Goffette
authors.forename: Françoise
authors.initials: F
authors.lastname: van de Wyngaert
authors.forename: Christian
authors.initials: C
authors.lastname: Raftopoulos
authors.forename: Philippe
authors.initials: P
authors.lastname: Hantson
mesh_terms: D000328:Adult; D001037:Aphasia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000503:physiopathology*; D004401:Dysarthria / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D005260:Female; D051270:Headache Disorders, Primary / Q000209:etiology; D006429:Hemiplegia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D014661:Vasoconstriction / Q000502:physiology*; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000503:physiopathology*
chemical_list: D014665:Vasodilator Agents