Unique combination of hyperintense vessel sign on initial FLAIR and delayed vasoconstriction on MRA in reversible cerebral vasoconstriction syndrome: a case report.
BACKGROUND
Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache and reversible cerebral vasoconstriction on angiographic findings. It can be difficult to diagnose when initial angiography is normal.


METHODS
A 30-year-old woman was admitted because of sudden-onset thunderclap headache and seizure on postpartum day 7. Brain MRI on fluid-attenuated inversion recovery (FLAIR) showed hyperintense vessel sign (HVS), which usually means slow flow due to severe proximal arterial stenosis. However, magnetic resonance angiography (MRA) indicated that proximal arteries was normal. After nicardipine treatment, her symptoms improved dramatically. Follow-up FLAIR on day 7 showed complete resolution of HVS, while a series of MRAs revealed reversible multifocal segmental vasoconstriction.


CONCLUSIONS
HVS on initial FLAIR is useful for an early diagnosis of reversible cerebral vasoconstriction syndrome. As the delayed vasoconstriction on MRA can be observed, reversible cerebral vasoconstriction syndrome may progress from distal small to proximal larger arteries.
Department of Neurology, Jichi Medical University, Japan kame-stroke@jichi.ac.jp.
Tomoaki
T
Kameda
Department of Neurology, Jichi Medical University, Japan.
Michito
M
Namekawa
Department of Neurology, Jichi Medical University, Japan.
Haruo
H
Shimazaki
Department of Neurology, Jichi Medical University, Japan.
Daisuke
D
Minakata
Department of Neurology, Jichi Medical University, Japan.
Tohru
T
Matsuura
Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
Imaharu
I
Nakano
D000328:Adult; D001808:Blood Vessels / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D013577:Syndrome; D014661:Vasoconstriction
Thunderclap headache; hyperintense vessel sign; reversible cerebral vasoconstriction syndrome