title: Reversible cerebral vasoconstriction syndrome.
abstract: Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache associated with multifocal vasoconstriction of cerebral arteries in patients without aneurysmal subarachnoid hemorrhage (SAH). The vasoconstriction reverts within three months. We report a 44-year-old man who had a thunderclap headache during sexual intercourse. A similar episode occurred at rest 36 hours later. The patient had already experienced a thunderclap headache 10 years earlier, during coitus. There were no abnormalities on examination. His brain computed tomography scan was normal and cerebrospinal fluid analysis showed no xanthochromia, 15 WBC/mm³ and 10 RBC/mm³. Lumbar puncture was repeated two days later (WBC = 3/mm³ and RBC = 43/mm³). An initial digital cerebral angiography showed a diffuse segmental intracerebral vasospasm. A new angiography after 15 days was normal. He remains headache-free after twenty six months. In conclusion, patients who have thunderclap headache with normal brain CT and cerebrospinal fluid without xantochromia should be investigated for this syndrome.
authors.affiliation: Hospital Universitario Oswaldo Cruz, University of Pernambuco, Recife, Brazil. pasrf@ig.com.br
authors.forename: Pedro Augusto
authors.initials: PA
authors.lastname: Sampaio Rocha Filho
authors.forename: Janayna
authors.initials: J
authors.lastname: Santos Barbosa
authors.forename: Ana Rosa
authors.initials: AR
authors.lastname: Melo Correa-Lima
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply*; D002561:Cerebrovascular Disorders / Q000134:cerebrospinal fluid / Q000209:etiology*; D051270:Headache Disorders, Primary / Q000209:etiology*; D006801:Humans; D008297:Male; D013577:Syndrome; D014661:Vasoconstriction; D020301:Vasospasm, Intracranial / Q000150:complications*