title: Reversible cerebral vasoconstriction syndrome manifesting as focal seizures without a thunderclap headache: A pediatric case report.
abstract: We report a pediatric case of reversible cerebral vasoconstriction syndrome with focal seizures without a thunderclap headache. A 7-year-old girl had a mild acute headache with nausea after swimming. She subsequently developed hemi-convulsions followed by right hemiplegia. Brain magnetic resonance angiography revealed generalized vasoconstriction of the main cerebral peripheral arteries. Her hemiplegia was spontaneously resolved within 6h. Over the next 24h she suffered from recurrent and transient headaches, which recurred on days 3 and 5. Follow-up magnetic resonance angiography on day 3 documented the multifocal narrowing of the main cerebral arteries, which was observed to have diminished at 12weeks after her initial presentation. She did not have any headaches or neurological deficits after day 5. This case indicates that reversible cerebral vasoconstriction syndrome should be considered in children with focal seizures even when they do not present with thunderclap headaches. The timely and appropriate evaluation by magnetic resonance angiography and imaging is essential for diagnosing reversible cerebral vasoconstriction syndrome.
authors.affiliation: Department of Pediatrics, Oita University Faculty of Medicine, Yufu-City, Oita, Japan; Department of Pediatrics, Nishida Hospital, Saiki-City, Oita, Japan. Electronic address: kugashuji@gmail.com.
authors.forename: Shuji
authors.initials: S
authors.lastname: Kuga
authors.affiliation: Department of Pediatrics, Oita University Faculty of Medicine, Yufu-City, Oita, Japan; Department of Pediatrics, Nishida Hospital, Saiki-City, Oita, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Goto
authors.affiliation: Department of Pediatrics, Oita University Faculty of Medicine, Yufu-City, Oita, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Okanari
authors.affiliation: Department of Pediatrics, Oita University Faculty of Medicine, Yufu-City, Oita, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Pediatrics, Oita University Faculty of Medicine, Yufu-City, Oita, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ihara
mesh_terms: D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D051270:Headache Disorders, Primary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006429:Hemiplegia / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D012640:Seizures / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Focal seizure; Hemiplegia; Reversible cerebral vasoconstriction syndrome