title: Acute headache at emergency department: reversible cerebral vasoconstriction syndrome complicated by subarachnoid haemorrhage and cerebral infarction.
abstract: Introduction. Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH) and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome. Case Report. A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache. Conclusion. Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that reversible cerebral vasoconstriction syndrome is still underrecognized, in particular in general emergency departments.
authors.affiliation: Unité Neurovasculaire, Hôpital de la Pitie-Salpetrière, APHP, 75013 Paris, France ; Université Pierre et Marie Curie, 75006 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Yger
authors.affiliation: Unité Neurovasculaire, Hôpital de la Pitie-Salpetrière, APHP, 75013 Paris, France ; Service de Rééducation Neurologique, Hôpital de la Pitie-Salpetrière, APHP, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Zavanone
authors.affiliation: Unité de Réanimation Neurologique, Hôpital de la Pitie-Salpetrière, APHP, 75013 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Abdennour
authors.affiliation: Unité de Réanimation Neurologique, Hôpital de la Pitie-Salpetrière, APHP, 75013 Paris, France.
authors.forename: W
authors.initials: W
authors.lastname: Koubaa
authors.affiliation: Université Pierre et Marie Curie, 75006 Paris, France ; Neuroradiologie, Hôpital de la Pitie-Salpetrière, APHP, 75013 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Clarençon
authors.affiliation: Université Pierre et Marie Curie, 75006 Paris, France ; Service de Rééducation Neurologique, Hôpital de la Pitie-Salpetrière, APHP, 75013 Paris, France ; Service d'Épilpeptologie, Hôpital de la Pitie-Salpetrière, APHP, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Dupont
authors.affiliation: Unité Neurovasculaire, Hôpital de la Pitie-Salpetrière, APHP, 75013 Paris, France ; Université Pierre et Marie Curie, 75006 Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Samson