Reversible Cerebral Vasoconstriction Syndrome without Headache That Was Initially Suspected of Being Primary Angiitis of the Central Nervous System

Abstract

A 48-year-old man had convulsions, and magnetic resonance angiography (MRA) showed diffuse constriction of the cerebral arteries. He was suspected of having primary angiitis of the central nervous system (PACNS) and treated with steroid for three days. The MRA abnormality disappeared after a week. After 69 days, he developed dizziness, and MRA revealed recurrence of cerebral artery stenosis. Nevertheless, the symptoms and abnormal MRA findings recovered promptly without treatment. He was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) without headache. This case suggests that RCVS should be a differential diagnosis in patients without headache whose MRA findings show multiple cerebral artery stenosis.

Reversible cerebral vasoconstriction syndrome: literature review

“…It can be a single, recurrent, or progressive episode, and pain intensity varies from moderate to severe. There are also reports of patients who do not have any headaches [ 10 , 65 ]. These atypical patients usually present with severe clinical symptoms and progress to stroke, severe posterior reversible encephalopathy syndrome, dizziness, mental confusion, or coma [ 10 ].…”