title: Reversible cerebral vasoconstriction syndrome and nonaneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Reversible cerebral vasoconstriction syndrome was first described by Call, Fleming, and colleagues. Clinically this entity presents acutely, with severe waxing and waning headaches ("thunderclap"), and occasional fluctuating neurological signs.
  
  
  METHODS
  We present four subsequent cases of patients with severe thunderclap headache and brain tomography with evidence of subarachnoid hemorrhage. The brain angiogram showed no aneurysm but intracranial vasculopathy consistent with multiple areas of stenosis and dilatation (angiographic beading) in different territories.
  
  
  CONCLUSIONS
  Neurologists should be aware of Call Fleming syndrome presenting with severe headache and associated convexity subarachnoid hemorrhage. After other diagnoses are excluded, patients can be reassured about favorable prognosis with symptomatic management.
  
  
  BACKGROUND
  RCVSReversible cerebral vasoconstriction syndromeCTComputed tomographySAHSubarachnoid hemorrhageMRMagnetic resonanceCTAComputed tomography angiographyMRAMagnetic resonance angiography.
authors.affiliation: Texas Tech University Health Sciences Center, Universidad de Costa Rica, El Paso, TX 79905-2709, USA.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Barboza
authors.affiliation: Department of Neurology and Radiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center.
authors.forename: Alberto
authors.initials: A
authors.lastname: Maud
authors.affiliation: Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center.
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodriguez
keywords: Call Fleming syndrome; cerebral vasoconstriction; nonaneurysmatic subarachnoid hemorrhage; thunderclap headache