Reversible Cerebral Vasoconstriction Syndrome Associated with Infundibular Dilation

Eur J Case Rep Intern Med. 2020 Aug 31;7(11):001839. doi: 10.12890/2020_001839. eCollection 2020.

Abstract

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is defined as a clinical and radiological syndrome that comprises a group of disorders characterized by sudden-onset severe headache and segmental vasoconstriction of the cerebral arteries with resolution within 3 months.

Case presentation: A 51-year-old female patient with a 2-week history of sudden-onset severe headache, visual disturbances and cerebellum; no relevant imaging findings, except for an infundibular dilation at the origin of the posterior communicating artery, and so, angiography was performed. When symptoms persisted, a new imaging study was carried out with findings of RCVS as the cause of the symptoms from the beginning.

Conclusions: Findings of RCVS can be obtained in various vasculopathies of the nervous system and vasculitis, being misdiagnosed, and so, clinical suspicion is essential; if vasoconstriction is not demonstrated on the initial image and other diagnoses have been excluded, the patient should be managed as having possible or probable RCVS.

Learning points: RCVS is a clinical and radiological syndrome that comprises a group of disorders characterized by sudden-onset severe headache and segmental vasoconstriction of the cerebral arteries.It can occur spontaneously or can be triggered by a specific "trigger" in 25 to 60% of cases.It commonly affects women between 20 and 50 years of age, but children and adolescents may also be affected.

Keywords: Reversible cerebral vasoconstriction syndrome; sudden-onset severe headache.