title: Reversible cerebral vasoconstriction syndrome after blood transfusion.
abstract: OBJECTIVE
  To report 2 cases of reversible cerebral vasoconstriction syndrome (RCVS) with posterior reversible encephalopathy syndrome (PRES) after blood transfusion for severe anemia.
  
  
  BACKGROUND
  RCVS is presented with recurrent thunderclap headache and reversible constriction of cerebral arteries. PRES is a known complication of RCVS. Blood transfusion for severe anemia could be a cause for PRES in few cases; however, it is seldom mentioned as an etiology for RCVS.
  
  
  METHODS
  We report a case series.
  
  
  RESULTS
  We report 2 women presented with RCVS with PRES after blood transfusion for anemia, and reviewed another 4 similar cases reported in the literature. Our 2 patients were middle-aged women, with severe chronic anemia (average hemoglobin: 1.45 g/dL), and received multiple blood transfusions (average: 3250 mL) over a period of 5-7 days. They developed thunderclap headache and other symptoms about 1 week after the last blood transfusion. Cerebral vasoconstrictions were demonstrated by magnetic resonance angiography and transcranial color-coded sonography. PRES was found in both of them using magnetic resonance imaging, and one of them also had cytotoxic edema on diffusion weighted image.
  
  
  CONCLUSIONS
  RCVS with PRES is one complication of blood transfusion in patients under chronic severe anemia (especially when hemoglobin level increased for more than 5 g/dL), particularly in Asian women with menorrhagia. Blood pressure surge and the occurrence of severe headaches or other neurological symptoms should be aggressively monitored within 10 days after the last blood transfusion.
authors.affiliation: Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Yi-Hsuan
authors.initials: YH
authors.lastname: Dou
authors.forename: Jong-Ling
authors.initials: JL
authors.lastname: Fuh
authors.forename: Shih-Pin
authors.initials: SP
authors.lastname: Chen
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
mesh_terms: D000740:Anemia / Q000628:therapy; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology* / Q000473:pathology; D065227:Transfusion Reaction; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000473:pathology
keywords: blood transfusion; chronic anemia; posterior reversible encephalopathy syndrome; reversible cerebral vasoconstriction syndrome