Reversible cerebral vasoconstriction syndrome as a cause of simultaneously ischemic and hemorrhagic stroke

• Main Author: Correia, Carlos Eduardo Rocha
• Publication Date: 2015
• Other Authors: Godeiro, Clécio de Oliveira, Loureiro, C., Loureiro, A., Linard, V., José, J., Laurentino, M., Santiago, P., Dourado, M.E., Melo, C., Marinho, M.
• Format: Article
• Language: por
• Source: Repositório Institucional da UFRN
• dARK ID: ark:/41046/001300000tk62
• Download full: https://repositorio.ufrn.br/handle/123456789/52534
• topic: hemorrhage; magnetic resonance angiography; hypertensive

Introduction: Reversible cerebral vasoconstriction syndrome(RCVS) is characterized by multifocal segmental vasoconstriction of cerebral arteries, which resolve spontaneously within 3 months, typically heralded by a sudden, severe headache with or without neurologic deficit. The main complications are intracranial hemorrhage, ischemic disturbance of the cerebral circulation, hypertensive encephalopathy (PRES) or epileptic seizures. Case: Female, 47 years old, hypertensive and no history of previous migraine, suddenly developed headache associated with paresis of the right upper limb. After a few hours of the onset of symptoms, a CT scan was performed and showed intraparenchymal hemorrhage in left temporal and parietal lobes. The patient evolved with partial and progressive improvement of the symptoms. A week later, a CT scan revealed ischemic area at the right parietal lobe. Magnetic Resonance Angiography was performed, which found narrowing of the right posterior and middle cerebral artery. The patient was treated with prednisone and nimodipine for 3 months. A 90 days later MRA revealed no vascular irregularity anymore. Discussion: Stroke, either hemorrhagic or ischemic is a relatively frequent presentation in RCVS, but simultaneously manifestations of intracerebral hemorrhage, and cerebral infarction was not described. More than half the cases (60%) are secondary to exposure to vasoactive substances or occur in the postpartum period. Cortical subarachnoid hemorrhage (22%), intracerebral hemorrhage (6%), seizures (3%), and reversible posterior leukoencephalopathy (9%) are early complication. Ischemic events, including TIAs (16%) and cerebral infarction (4%), occur later than hemorrhagic strokes. Several case series have reported success with calcium channel blockers or short term glucocorticoids medications.