DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162158

Fulminant reversible cerebral vasoconstriction syndrome in post-partum female

Rambir Singh, Shilpi Mittal, Alsaba Khan, Bharat Gupta, Narendra Kardam, Kushal Gehlot

Abstract


Reversible cerebral vasoconstriction syndrome (RCVS) is a clinical and radiologic syndrome that represents a common presentation of a diverse group of disorders. Call-Fleming syndrome which is a part of RCVS group. We present a case of 30 year old primigravida who developed thunderclap headache followed by seizures on her day 1 of postpartum period. MRI revealed left anterior cerebral artery infarct with vasoconstriction of bilateral internal carotid arteries and its branches. She was managed conservatively. Follow up on 25th day revealed complete reversal of vasoconstriction in above mentioned arteries which confirmed the diagnosis of Call-Fleming syndrome. Patient had residual aphasia and right lower limb paresis on 2 months follow up.

Keywords


RCVS, Call-Fleming syndrome, Pregnancy

Full Text:

PDF

References


Ducros A. L37: reversible cerebral vasoconstriction syndrome distinction from CNS vasculitis. Presse Med. 2013;42(4 pt 2):602-04.

Ducros A, Bousser MG. Reversible cerebral vasoconstriction syndrome. Pract Neurol. 2009;9:256-67.

Gupta S, Zivadinov R, Ramasamy D, Ambrus JL. Reversible cerebral vasoconstriction syndrome (RCVS) in antiphospholipid antibody syndrome (APLA): the role of centrally acting vasodilators case series and review of literature. Clin Rheumatol. 2014;33:1829-33.

Marder CP, Donohue MM, Weinstein JR, Fink KR. Multimodal imaging of reversible cerebral vasoconstriction syndrome: a series of 6 cases. AJNR Am J Neuroradiol. 2012;33:1403-10.

Sheikh HU, Mathew PG. Reversible cerebral vasoconstriction syndrome: updates and new perspectives. Curr Pain Headache Rep. 2014;18:414.

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):3091-101.

Schwedt TJ, Matharu MS, Dodick DW. Thunderclap headache. Lancet Neurol. 2006;5:621-31.

Newell CP, Seller C, Vizhi M, Turner N. Case report: spontaneous coronary artery dissection during elective caesarean section under spinal anaesthesia. Anaesthesia. 2011;66:615-9.

Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med. 2007;146:34-44.

Tienviboon C, Punyagupta S, Pongtarakulpanit A, Prichanond S. Reversible cerebral vasoconstriction syndrome with increased intracranial pressure, probably related to altitude changes and windy winter travelling. J Med Assoc Thai. 2011;94:622-8.

Call GK, Fleming MC, Sealfon S, Levine H, Kistler JP, Fisher CM. Reversible cerebral segmental vasoconstriction. Stroke. 1988;19:1159-70.

Moustafa RR, Allen CM, Baron JC. Call-Fleming syndrome associated with subarachnoid haemorrhage: Three new cases. J Neurol Neurosurg Psychiatry. 2008;79:602-5.

The International Classification of Headache Disorders: 2nd edn. Cephalalgia. 2004;24(Suppl 1):9-160.

Calic Z, Choong H, Schlaphoff G, Cappelen-Smith C. Reversible cerebral vasoconstriction syndrome following indomethacin. Cephalalgia. 2014;34:1181-6.

Grooters GS, Sluzewski M, Tijssen CC. How often is thunderclap headache caused by the reversible cerebral vasoconstriction syndrome? Headache. 2014;54:732-5.

Chen SP, Fuh JL, Wang SJ. Reversible cerebral vasoconstriction syndrome: an under-recognized clinical emergency. Therapeutic Advances in Neurological Disorders. 2010;3(3):161-71.

Birnbaum J, Hellmann DB. Primary angiitis of the central nervous system. Arch Neurol. 2009;66:704-9.

Fletcher JJ, Kramer AH, Bleck TP, Solenski NJ. Overlapping features of eclampsia and postpartum angiopathy. Neurocrit Care. 2009;11:199-209.

Geraghty JJ, Hoch DB, Robert ME, Vinters HV. Fatal puerperal cerebral vasospasm and stroke in a young woman. Neurology. 1991;41:1145-7.

Singhal AB, Kimberly WT, Schaefer PW, Hedley-Whyte ET. Case records of the massachusetts general hospital. Case 8-2009. A 36-yearold woman with headache, hypertension, and seizure 2 weeks postpartum. N Engl J Med. 2009;360:1126-37.

Karmacharya R, Singh M, Rawal S. Call Fleming syndrome: case report. Nepal J Neurosci. 2008;5:60-1.

Cvetanovich GL, Ramakrishnan P, Klein JP, Rao VR, Ropper AH. Reversible cerebral vasoconstriction syndrome in a patient taking citalopram and hydroxycut: a case report. J Med Case Rep. 2011;5:548.