Reversible cerebral vasoconstriction syndrome with cortical subarachnoid hemorrhage presenting as thunderclap headache—a long followed up case—

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  • Ogura Aya
    Department of Neurology, Stroke Center, TOYOTA Memorial Hospital
  • Suzuki Junichiro
    Department of Neurology, Stroke Center, TOYOTA Memorial Hospital Present address: Department of Neurology, Nagoya University Graduate School of Medicine
  • Imai Kazunori
    Department of Neurology, Stroke Center, TOYOTA Memorial Hospital
  • Nishida Suguru
    Department of Neurology, Stroke Center, TOYOTA Memorial Hospital
  • Kato Takashi
    Department of Neurology, Stroke Center, TOYOTA Memorial Hospital Present address: Grace Hospital
  • Yasuda Takeshi
    Department of Neurology, Stroke Center, TOYOTA Memorial Hospital
  • Ito Yasuhiro
    Department of Neurology, Stroke Center, TOYOTA Memorial Hospital

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Other Title
  • 雷鳴頭痛と皮質性くも膜下出血で発症し，長期経過を観察したreversible cerebral vasoconstriction syndromeの1例
  • 症例報告 雷鳴頭痛と皮質性くも膜下出血で発症し,長期経過を観察したreversible cerebral vasoconstriction syndromeの1例
  • ショウレイ ホウコク ライメイ ズツウ ト ヒシツセイク モ マク カ シュッケツ デ ハッショウ シ,チョウキ ケイカ オ カンサツ シタ reversible cerebral vasoconstriction syndrome ノ 1レイ

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Abstract

A 59-year-old woman presented with thunderclap headache. Cranial CT showed cortical subarachnoid hemorrhage (cSAH) at the right parietal lobe and cerebral angiography on day 5 revealed multiple cerebral arterial constriction, diagnosed as reversible cerebral vasoconstriction syndrome (RCVS). We could not detect vasoconstriction in MRA at the first examination on day 4, and vasoconstrictive finding appeared around Willis circle 8 days later. There was a temporal difference in a cephalalgic symptom and vasoconstrictive appearance. Clinical symptoms completely recovered and head CT, MRI/MRA findings were reversible after two months, reflecting a rather good RCVS outcome. However, we also followed up this case precisely using single photon emission computed tomography (SPECT) with easy Z-score imaging system (e-ZIS), and hypoperfusion at the locus of cSAH persisted for more than one year. This finding strongly suggests that tissue damage in the cSAH locus induced by RCVS may be subclinicaly irreversible, even though clinical symptoms and abnormalities in cranial MRI and MRA completely recover.SPECT may be a high sensitive technique to detect the irreversible lesion in RCVS.

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 53 (8), 618-623, 2013

    Societas Neurologica Japonica

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