title: Call-Fleming syndrome: headache in a 16-year-old girl.
abstract: BACKGROUND
  Call-Fleming syndrome, also known as reversible cerebral vasoconstriction syndrome, is an important cause of severe headache characterized by segmental constriction of cerebral arteries in multiple vascular distributions. It is commonly described in adults, with a female predominance.
  
  
  METHODS
  We report a case of a 16-year-old girl with history of anxiety, attention deficit hyperactivity disorder, and migraines on several medications presenting with 2 weeks of worsening headaches.
  
  
  RESULTS
  Cranial computed tomography was normal, but magnetic resonance imaging revealed cortical subarachnoid hemorrhage. Follow-up imaging demonstrated extensive vasoconstriction of small- to medium-sized cerebral arteries. Sertraline and methylphenidate were discontinued, and nifedipine was started. Symptoms rapidly improved, and repeat angiography at 2 months showed no vasoconstriction.
  
  
  CONCLUSIONS
  Call-Fleming syndrome is an important cause of thunderclap headache and should be considered in the pediatric population, especially in the setting of certain medication usage and other known risk factors.
authors.affiliation: University of Medicine and Dentistry of New Jersey - New Jersey Medical School, Newark, New Jersey, USA. jenniferbain08@gmail.com
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bain
authors.forename: Devorah
authors.initials: D
authors.lastname: Segal
authors.forename: Ruchi
authors.initials: R
authors.lastname: Amin
authors.forename: David
authors.initials: D
authors.lastname: Monoky
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000792:Angiography; D001007:Anxiety / Q000150:complications; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications; D005260:Female; D006261:Headache / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009543:Nifedipine / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000150:complications* / Q000188:drug therapy
chemical_list: D014665:Vasodilator Agents; D009543:Nifedipine