title: Reversible cerebral vasoconstriction syndrome.
abstract: Reversible cerebral vasoconstriction syndrome (RCVS) is a relatively rare, non-progressive angiopathy frequently heralded by severe thunderclap headache. It is characterised by vasoconstriction of cerebral arteries which usually resolves within three months of onset. Transient focal neurological signs may occur, and persistent deficits associated with haemorrhagic comorbidities have been reported in a small percentage of individuals. In this paper we report the case of RH, a 36-year-old woman who presented at a university teaching hospital in Sydney with a clinical history and radiological evidence consistent with RCVS. There were no haemorrhagic events during the course of her illness, and vasoconstriction resolved within a few days, following treatment with verapamil. Neuropsychological evaluation 16 months later revealed significant deficits in autobiographical memory, verbal and non-verbal new learning and active delayed recall, cognitive flexibility, abstraction and (to a lesser extent) immediate attention span and information processing speed. RH's case was unusual because the "trigger" for RCVS (Ear, Nose and Throat surgery) has not been previously reported, and because despite there being no haemorrhagic complications during the course of RCVS and no subsequent radiological abnormalities, she had significant cognitive impairment. To date, persistent neuropsychological deficits have not been recognised as a feature of RCVS.
authors.affiliation: a Department of Neurology , Royal North Shore Hospital , Sydney , Australia.|b Discipline of Psychiatry , The University of Sydney Medical School, Northern Clinical School , Sydney , Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Perdices
authors.affiliation: a Department of Neurology , Royal North Shore Hospital , Sydney , Australia.|c Kolling Institute, University of Sydney , Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Herkes
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D051270:Headache Disorders, Primary / Q000209:etiology; D006801:Humans; D009483:Neuropsychological Tests; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology*; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D014700:Verapamil
keywords: Angiopathy; RCVS; neuropsychological impairment