Idiopathic reversible cerebral vasoconstriction syndrome in a female patient complicated by subarachnoid haemorrhage: A case report

Abstract

Introduction: RCVS is a cerebrovascular disorder characterized by multisegmental narrowing of the cerebral arteries with a spontaneous resolution in 1-3 months. It most commonly presents as a sudden onset of a "thunderclap" headache which may be associated with mild neurological symptoms. It may be complicated by subarachnoid haemorrhage, intracerebral haemorrhage, stroke or seizures. Diagnosis is confirmed by "string of beads appearance" of the intracerebral arteries on a cerebral angiography. Case presentation: We present a case of a 65-year-old female, who presented with sudden onset of intense headache and associated with visual disturbances (homonymous hemianopia) with CT evidence of subarachnoid haemorrhage in the superficial cortical sulci. Catheter angiography showed string of beads pattern with focal areas of vasoconstriction and dilatation. Provisional diagnosis of RCVS was made and the patient was treated with calcium channel blockers. Patient demonstrated complete resolution of symptoms and got discharged. Conclusion: RCVS is being increasingly recognised as one of the causes of thunderclap headaches and demonstrates characteristic abnormalities on angiography which are reversible over time. High degree of suspicion and timely diagnosis can potentially reduce the morbidity.