Reversible cerebral vasoconstriction syndrome following indomethacin.
BACKGROUND
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe thunderclap headaches and transient segmental cerebral arterial vasoconstriction. Precipitating factors, including the postpartum state and exposure to vasoactive substances are identified in approximately 50% of cases. Non-steroidal anti-inflammatory drugs have rarely been associated with RCVS.


METHODS
We report a case of a 51-year-old female with RCVS after administration of indomethacin given to relieve pain caused by renal colic. Cerebral imaging showed non-aneurysmal cortical subarachnoid hemorrhage, and formal angiography demonstrated widespread multifocal segmental narrowing of medium-sized cerebral arteries. These changes resolved on repeat angiography at 3 weeks.


CONCLUSIONS
Indomethacin is a commonly used drug for treatment of certain primary headache disorders. To date, its mechanism of action remains unclear. A well described side effect of indomethacin is headache, which may be secondary to its vasoconstrictive effects. In our case, we postulate indomethacin, either alone or in combination with emotional stress from pain, triggered or exacerbated an underlying predisposition to RCVS.
Department of Neurology and Neurophysiology, Liverpool Hospital, Australia South Western Sydney Clinical School, University of New South Wales, Australia.
Zeljka
Z
Calic
Department of Neurology and Neurophysiology, Liverpool Hospital, Australia South Western Sydney Clinical School, University of New South Wales, Australia.
Ho
H
Choong
Department of Radiology, Liverpool Hospital, Australia.
Glen
G
Schlaphoff
Department of Neurology and Neurophysiology, Liverpool Hospital, Australia South Western Sydney Clinical School, University of New South Wales, Australia c.cappelensmith@unsw.edu.au.
Cecilia
C
Cappelen-Smith
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002533:Cerebral Angiography; D005260:Female; D051270:Headache Disorders, Primary / Q000139:chemically induced*; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects*; D008875:Middle Aged; D056844:Renal Colic / Q000188:drug therapy; D020301:Vasospasm, Intracranial / Q000139:chemically induced*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin
Thunderclap headache; indomethacin; reversible cerebral vasoconstriction syndrome