Miguel A Barboza1, Alberto Maud2, Gustavo J Rodriguez3. 1. Texas Tech University Health Sciences Center, Universidad de Costa Rica, El Paso, TX 79905-2709, USA. 2. Department of Neurology and Radiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center. 3. Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center.
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. CASE PRESENTATION: 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. CONCLUSION: 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. ABBREVIATIONS: RCVSReversible cerebral vasoconstriction syndromeCTComputed tomographySAHSubarachnoid hemorrhageMRMagnetic resonanceCTAComputed tomography angiographyMRAMagnetic resonance angiography.
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. CASE PRESENTATION: 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. CONCLUSION: 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. ABBREVIATIONS: RCVSReversible cerebral vasoconstriction syndromeCTComputed tomographySAHSubarachnoid hemorrhageMRMagnetic resonanceCTAComputed tomography angiographyMRAMagnetic resonance angiography.