Reversible cerebral vasoconstriction syndrome associated with putaminal hemorrhage

Síndrome da vasoconstrição cerebral reversível associada a hemorragia putaminal

A 42-year-old woman with history of analgesic overuse and episodic migraine without aura presented thunderclap headache. She then ingested 4.5 g of dipyrone, 0.75 g of isometheptene, 0.45 g of caffeine and subsequently developed right hemiparesis and dysarthria. Brain computed tomography (CT) and digital subtraction angiography (DSA) are shown, respectively, in Figures 1A and 1B. Transcranial doppler (TCD) showed indirect signs of vasospasm. Symptoms subsided after 10 days. Follow-up eight-week magnetic ressonance angiography (MRA) and TCD were normal, as well as twelve-week DSA (Figure 1C). The diagnosis was reversible cerebral vasoconstriction syndrome associated with unusual putaminal hemorrhage after caffeine and isometheptene abuse^1,2,3.

Figure
. Brain CT shows a left striatal hematoma (arrow) (A). Initial DSA demonstrates focal narrowings separated by areas of normal caliber (“beading pattern”) especially in the right middle and anterior cerebral arteries (arrows) (B). Arterial walls are smooth and regular. There are no true arterial dilatations or occlusions that would support a diagnosis of intracranial arterial dissection. Follow-up twelve-week DSA shows no signs of vasospasm (C).

References

• ¹
  Call GK, Fleming MC, Sealfon S, Levine H, Kistler JP, Fisher CM. Reversible cerebral segmental vasoconstriction. Stroke 1988;19:1159-1170.
• ²
  Sattar A, Manousakis G, Jensen MB. Systematic review of reversible cerebral vasoconstriction syndrome. Expert Rev Cadiovasc Ther 2010;8:1417-1421.
• ³
  Singhal AB, Hajj-Ali RA, Topcuoqlu MA, et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 2011;68:1005-1012.

Publication Dates

• Publication in this collection
  July 2014

History

• Received
  11 Apr 2014
• Accepted
  05 May 2014