Reversible Cerebral Vasoconstriction Syndrome Presenting as Subarachnoid Hemorrhage, Reversible Posterior Leukoencephalopathy, and Cerebral Infarction

Kazuyuki Noda; Jiro Fukae; Kenji Fujishima; Kentaro Mori; Takao Urabe; Nobutaka Hattori; Yasuyuki Okuma

doi:10.2169/internalmedicine.50.4812

CASE REPORTS

Reversible Cerebral Vasoconstriction Syndrome Presenting as Subarachnoid Hemorrhage, Reversible Posterior Leukoencephalopathy, and Cerebral Infarction

Kazuyuki Noda, Jiro Fukae, Kenji Fujishima, Kentaro Mori, Takao Urabe, Nobutaka Hattori, Yasuyuki Okuma

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Keywords: vasoconstriction, Call-Fleming syndrome, cortical subarachnoid hemorrhage, aneurysm, cerebral infarction, reversible posterior leukoencephalopathy syndrome

JOURNAL OPEN ACCESS

2011 Volume 50 Issue 11 Pages 1227-1233

DOI https://doi.org/10.2169/internalmedicine.50.4812

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Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute severe headache with or without additional neurological symptoms and reversible cerebral vasoconstriction. Unruptured aneurysm has been reported in some cases with RCVS. We report a severe case of a 53-year-old woman with RCVS having an unruptured cerebral aneurysm and presenting as cortical subarachnoid hemorrhage, reversible posterior leukoencephalopathy syndrome, and cerebral infarction. She was successfully treated with corticosteroids and a calcium channel blocker and the aneurysm was clipped. Her various complications are due to the responsible vasoconstriction that started distally and progressed towards proximal arteries. This case demonstrates the spectrum of presentations of RCVS, a clinically complicated condition.

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