Reversible cerebral vasoconstriction syndrome with posterior leucoencephalopathy after oral contraceptive pills.
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset recurrent 'thunderclap' headaches with reversible multifocal narrowing of the cerebral arteries, often associated with focal neurological deficits from ischaemic or haemorrhagic stroke. It has been associated with exposure to vasoconstrictive drugs, pregnancy, migraine, and a variety of other conditions. Whereas the pathophysiology of RCVS remains unclear, changes in the levels of female hormones are considered important because RCVS predominantly affects women and is frequently associated with pregnancy. We report a patient with angiographically confirmed RCVS whose MRI showed reversible brain oedema, suggesting an overlap between RCVS and the reversible posterior leucoencephalopathy syndrome. The only identified risk factor was oral contraceptive pills started 1 month prior to onset, supporting a role for female reproductive hormones in precipitating this overlap syndrome.
Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
Y
Y
Soo
A B
AB
Singhal
T
T
Leung
S
S
Yu
H
H
Mak
Q
Q
Hao
H
H
Leung
W
W
Lam
L K S
LK
Wong
D000328:Adult; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D005260:Female; D012739:Gonadal Steroid Hormones / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D014661:Vasoconstriction / Q000187:drug effects*
D003278:Contraceptives, Oral, Hormonal; D012739:Gonadal Steroid Hormones