Abstract
A 28-year-old woman had thunderclap headache (TCH), after 7 days she had left hemiparesis. She had a history of oral contraceptive and citalopram medications. Brain magnetic resonance (MR) angiography demonstrated multiple stenotic segments. Digital subtraction angiography (DSA) showed multiple segments of narrowing in vessel calibre. Two probable diagnoses performed; primary angiitis of the central nervous system and reversible cerebral vasoconstriction syndrome (RCVS). Because of clinical characteristics and normal cerebrospinal fluid findings she was set on medication for probable RCVS. Follow-up MR angiography after 4 weeks and DSA after 7 weeks demonstrated improvement in vessel calibre. Thus, diagnosis RCVS was established. Diagnosis and management of TCH contain many potential difficulties. Clinicians should consider the imaging of cerebral arteries, even if computed tomography scan and lumbar puncture are normal in TCH. Potential precipitating factors and triggers should also be known and avoided.
Keywords: Reversible cerebral vasoconstriction syndrome, Thunderclap headache, Digital subtraction angiography, Selective-serotonin reuptake inhibitors
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Acknowledgments
Conflict of interest
None.
Footnotes
This case was presented as a poster at the European Headache and Migraine Trust International Congress (EHMTIC), 4–7th September 2008, London, UK entitled “The Call–Fleming Syndrome: case report”.
References
- 1.Call GK, Fleming ML, Sealfon S, Levine H, Kistler JP, Fisher CM. Reversible cerebral segmental vasoconstriction. Stroke. 1988;19:1159–1170. doi: 10.1161/01.str.19.9.1159. [DOI] [PubMed] [Google Scholar]
- 2.Ducros A, Boukobza M, Porcher R, Sarov M, Valade D, Bousser MG. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain. 2007;130(Pt 12):3091–3101. doi: 10.1093/brain/awm256. [DOI] [PubMed] [Google Scholar]
- 3.Singhal AB, Caviness VS, Begleiter AF, Mark EJ, Rordorf G, Koroshetz WJ. Cerebral vasoconstriction and stroke after use of serotonergic drugs. Neurology. 2002;58:130–133. doi: 10.1212/wnl.58.1.130. [DOI] [PubMed] [Google Scholar]
- 4.Koopman K, Teune LK, Ter Laan M, Uyttenboogaart M, Vroomen PC, Keyser J, Luijckx GJ. An often unrecognized cause of thunderclap headache: reversible cerebral vasoconstriction syndrome. J Headache Pain. 2008;9(6):389–391. doi: 10.1007/s10194-008-0068-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Reneman L, Habraken JB, Majoie CB, Booij J, Heeten GJ. MDMA (‘Ecstasy’) and its association with cerebrovascular accidents: preliminary findings. Am J Neuroradiol. 2000;21:1001–1007. [PMC free article] [PubMed] [Google Scholar]
- 6.Neudecker S, Stock K, Krasnianski M. Call–Fleming postpartum angiopathy in the puerperium: a reversible cerebral vasoconstriction syndrome. Obstet Gynecol. 2006;107(2 Pt 2):446–449. doi: 10.1097/01.AOG.0000187945.61146.e6. [DOI] [PubMed] [Google Scholar]
- 7.Moustafa RR, Allen CM, Baron JC. Call–Fleming syndrome associated with subarachnoid haemorrhage: three new cases. J Neurol Neurosurg Psychiatry. 2008;79(5):602–605. doi: 10.1136/jnnp.2007.134635. [DOI] [PubMed] [Google Scholar]
- 8.Keyrouz S, Dhar R, Axelrod Y. Call–Fleming syndrome and orgasmic cephalgia. Headache. 2008;48(6):967–971. doi: 10.1111/j.1526-4610.2008.01144.x. [DOI] [PubMed] [Google Scholar]
- 9.Koopman K, Uyttenboogaart M, Luijckx GJ, Keyser J, Vroomen PC. Pitfalls in the diagnosis of reversible cerebral vasoconstriction syndrome and primary angiitis of the central nervous system. Eur J Neurol. 2007;14:1085–1087. doi: 10.1111/j.1468-1331.2007.01830.x. [DOI] [PubMed] [Google Scholar]
- 10.Dodick DW. Reversible segmental cerebral vasoconstriction (Call–Fleming syndrome): the role of calcium antagonists. Cephalalgia. 2003;23(3):163–165. doi: 10.1046/j.1468-2982.2003.00506.x. [DOI] [PubMed] [Google Scholar]
- 11.Chen SP, Fuh JL, Lirng JF, Chang FC, Wang SJ. Recurrent primary thunderclap headache and benign CNS angiopathy: spectra of the same disorder? Neurology. 2006;67(12):2164–2169. doi: 10.1212/01.wnl.0000249115.63436.6d. [DOI] [PubMed] [Google Scholar]