Reversible Cerebral Vasoconstriction Syndrome Induced by Pseudoephedrine
Background: Thunderclap headache and focal neurologic deficits are major diagnostic challenges to the neurologists. Besides subarachnoid hemorrhage and stroke, reversible cerebral vasoconstriction syndrome (RCVS) should be given high priority in the differential diagnosis. Case Report: A 46-year-old...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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The Korean Neurocritical Care Society
2016-06-01
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| Series: | Journal of Neurocritical Care |
| Subjects: | |
| Online Access: | http://www.e-jnc.org/upload/pdf/jnc-9-1-28.pdf |
| _version_ | 1818310370496872448 |
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| author | Dong Hyun Lee Seung-Cheol Lee Nari Choi Sang-Woo Lee Tae-Kyeong Lee |
| author_facet | Dong Hyun Lee Seung-Cheol Lee Nari Choi Sang-Woo Lee Tae-Kyeong Lee |
| author_sort | Dong Hyun Lee |
| collection | DOAJ |
| description | Background: Thunderclap headache and focal neurologic deficits are major diagnostic challenges to the neurologists. Besides subarachnoid hemorrhage and stroke, reversible cerebral vasoconstriction syndrome (RCVS) should be given high priority in the differential diagnosis. Case Report: A 46-year-old woman visited our hospital with thunderclap headache and left hemiparesis. Computed tomography (CT) angiography showed multifocal narrowing of the basilar artery. Headache, resistant to conventional medication, had a waxing and waning course during hospitalization. After a review of the medication history, administration of pseudoephedrine for allergic rhinitis was noted 3 days before hospital admission. History of a prior episode of severe headache after taking the same medication was also revealed. Under suspicion of secondary RCVS related to sympathomimetics, she was treated with nimodipine, and then, the headache improved gradually. Follow-up CT angiography showed normalization of the previously narrowed cerebral vessels. Conclusion: The problem of underdiagnosis of RCVS cannot be overcome without a high level of vigilance. Thunderclap headache with normal brain parenchyma on MRI but multifocal narrowing of brain vessels highly suggests the need for scrutiny of potential triggers of RCVS. |
| first_indexed | 2024-12-13T07:44:59Z |
| format | Article |
| id | doaj.art-239380c805b34552bea870a2cf282698 |
| institution | Directory Open Access Journal |
| issn | 2005-0348 2508-1349 |
| language | English |
| last_indexed | 2024-12-13T07:44:59Z |
| publishDate | 2016-06-01 |
| publisher | The Korean Neurocritical Care Society |
| record_format | Article |
| series | Journal of Neurocritical Care |
| spelling | doaj.art-239380c805b34552bea870a2cf2826982022-12-21T23:54:52ZengThe Korean Neurocritical Care SocietyJournal of Neurocritical Care2005-03482508-13492016-06-0191283210.18700/jnc.2016.9.1.28223Reversible Cerebral Vasoconstriction Syndrome Induced by PseudoephedrineDong Hyun Lee0Seung-Cheol Lee1Nari Choi2Sang-Woo Lee3Tae-Kyeong Lee4Department of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, KoreaDepartment of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, KoreaDepartment of Neurology, Soonchunhynag University College of Medicine, Soonchunhyang University Hospital, Seoul, KoreaDepartment of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, KoreaDepartment of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, KoreaBackground: Thunderclap headache and focal neurologic deficits are major diagnostic challenges to the neurologists. Besides subarachnoid hemorrhage and stroke, reversible cerebral vasoconstriction syndrome (RCVS) should be given high priority in the differential diagnosis. Case Report: A 46-year-old woman visited our hospital with thunderclap headache and left hemiparesis. Computed tomography (CT) angiography showed multifocal narrowing of the basilar artery. Headache, resistant to conventional medication, had a waxing and waning course during hospitalization. After a review of the medication history, administration of pseudoephedrine for allergic rhinitis was noted 3 days before hospital admission. History of a prior episode of severe headache after taking the same medication was also revealed. Under suspicion of secondary RCVS related to sympathomimetics, she was treated with nimodipine, and then, the headache improved gradually. Follow-up CT angiography showed normalization of the previously narrowed cerebral vessels. Conclusion: The problem of underdiagnosis of RCVS cannot be overcome without a high level of vigilance. Thunderclap headache with normal brain parenchyma on MRI but multifocal narrowing of brain vessels highly suggests the need for scrutiny of potential triggers of RCVS.http://www.e-jnc.org/upload/pdf/jnc-9-1-28.pdfVasoconstrictionThunderclap headachePseudoephedrine |
| spellingShingle | Dong Hyun Lee Seung-Cheol Lee Nari Choi Sang-Woo Lee Tae-Kyeong Lee Reversible Cerebral Vasoconstriction Syndrome Induced by Pseudoephedrine Journal of Neurocritical Care Vasoconstriction Thunderclap headache Pseudoephedrine |
| title | Reversible Cerebral Vasoconstriction Syndrome Induced by Pseudoephedrine |
| title_full | Reversible Cerebral Vasoconstriction Syndrome Induced by Pseudoephedrine |
| title_fullStr | Reversible Cerebral Vasoconstriction Syndrome Induced by Pseudoephedrine |
| title_full_unstemmed | Reversible Cerebral Vasoconstriction Syndrome Induced by Pseudoephedrine |
| title_short | Reversible Cerebral Vasoconstriction Syndrome Induced by Pseudoephedrine |
| title_sort | reversible cerebral vasoconstriction syndrome induced by pseudoephedrine |
| topic | Vasoconstriction Thunderclap headache Pseudoephedrine |
| url | http://www.e-jnc.org/upload/pdf/jnc-9-1-28.pdf |
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