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Table of Contents    
NEUROIMAGE
Year : 2016  |  Volume : 64  |  Issue : 1  |  Page : 187

Reversible cerebral vasoconstriction syndrome presenting with severe headache and seizures


1 Department of Neurology, Interventional Radiology and Neuroradiology, Wrocław Medical University, Poland
2 Department of General Radiology, Interventional Radiology and Neuroradiology, Wrocław Medical University, Poland

Date of Web Publication11-Jan-2016

Correspondence Address:
Marta Waliszewska-Prosol
Department of Neurology, Wrocław Medical University, ul. Borowska 213, 50.556 Wrocław
Poland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.173642

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How to cite this article:
Waliszewska-Prosol M, Bladowska J, Zagrajek M, Pokryszko-Dragan A, Podemski R. Reversible cerebral vasoconstriction syndrome presenting with severe headache and seizures. Neurol India 2016;64:187

How to cite this URL:
Waliszewska-Prosol M, Bladowska J, Zagrajek M, Pokryszko-Dragan A, Podemski R. Reversible cerebral vasoconstriction syndrome presenting with severe headache and seizures. Neurol India [serial online] 2016 [cited 2019 Aug 25];64:187. Available from: http://www.neurologyindia.com/text.asp?2016/64/1/187/173642


A 65-year-old female patient without any previous medical history was admitted to the Neurology Department with severe headache that had been persisting for 2 months. It was associated with recurrent vomiting and focal motor seizures of the right hand. On examination, no neurological deficits were found. Computed tomography scan revealed a small hemorrhage in the left temporo-occipital region. Cerebral magnetic resonance showed changes typical of the reversible cerebral vasoconstriction syndrome (RCVS) [Figure 1]. Laboratory tests revealed elevated levels of total serum cholesterol and low-density lipoprotein. Electroencephalogram and laboratory tests for vasculitis were within the normal limit. Following treatment with nimodipine, the headache and seizures subsided. The abnormalities on neuroimaging resolved after some time [Figure 2]. RCVS is rare but should be included in the differential diagnosis of severe headaches.1
Figure 1: (a) Fluid attenuation inversion recovery image showed hyperintense lesions in the left temporo-occipital region suggesting the presence of acute ischemia; (b) diffusion weighted imaging examination confirmed the acute ischemic lesions with signs of restricted diffusion; (c) fluid attenuation inversion recovery image also showed the convexity subarachnoid hemorrhage in the left frontal area; and, (d) computed tomography angiography revealed focal narrowing of the left middle cerebral artery and distal branches of the left posterior cerebral artery

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Figure 2: Comparison of the computed tomography angiography performed in April (a) and in September (b). The follow-up examination revealed normal appearing cerebral vessels

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


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  [Figure 1], [Figure 2]



 

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