Reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning: A case report
Abstract An 81‐year‐old woman with a history of hypertension and Alzheimer's disease presented to the emergency department because of impaired consciousness. Physical examination revealed acute progressive generalized flaccid paralysis, hypertension, respiratory failure, and pupillary dilation....
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-12-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12627 |
| _version_ | 1819283174366117888 |
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| author | Eiichi Kakehi Makoto Matsumoto Shohei Taniguchi Yukinobu Akamatsu Shigehisa Sakurai Akane Hirotani Takafumi Nozaki Keisuke Shoji Seiji Adachi Kazuhiko Kotani Masami Matsumura |
| author_facet | Eiichi Kakehi Makoto Matsumoto Shohei Taniguchi Yukinobu Akamatsu Shigehisa Sakurai Akane Hirotani Takafumi Nozaki Keisuke Shoji Seiji Adachi Kazuhiko Kotani Masami Matsumura |
| author_sort | Eiichi Kakehi |
| collection | DOAJ |
| description | Abstract An 81‐year‐old woman with a history of hypertension and Alzheimer's disease presented to the emergency department because of impaired consciousness. Physical examination revealed acute progressive generalized flaccid paralysis, hypertension, respiratory failure, and pupillary dilation. Although the patient did not complain of headache, head magnetic resonance angiography and magnetic resonance imaging showed multifocal segmental cerebral vasospasm and cerebral infarction in the left occipital lobe. Her family reported that although she did not have a license to cook pufferfish, she was in the habit of eating pufferfish. We subsequently detected tetrodotoxin in the patient's urine, and she was diagnosed with tetrodotoxin poisoning. As the symptoms of tetrodotoxin intoxication improved, head magnetic resonance angiography showed the disappearance of the multifocal segmental cerebral vasospasm. The patient's clinical course and imaging findings were consistent with reversible cerebral vasoconstriction syndrome (RCVS). Sympathetic overactivity after tetrodotoxin intoxication possibly caused the development of RCVS, and RCVS could not be ruled out even in the absence of the typical thunderclap headache. Magnetic resonance angiography is a useful modality when performing repeated examinations. |
| first_indexed | 2024-12-24T01:27:17Z |
| format | Article |
| id | doaj.art-982dc4719d68481d8d89763b47f010cc |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-12-24T01:27:17Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-982dc4719d68481d8d89763b47f010cc2022-12-21T17:22:27ZengWileyJournal of the American College of Emergency Physicians Open2688-11522021-12-0126n/an/a10.1002/emp2.12627Reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning: A case reportEiichi Kakehi0Makoto Matsumoto1Shohei Taniguchi2Yukinobu Akamatsu3Shigehisa Sakurai4Akane Hirotani5Takafumi Nozaki6Keisuke Shoji7Seiji Adachi8Kazuhiko Kotani9Masami Matsumura10Department of General Medicine Tottori Municipal Hospital Tottori‐City Tottori JapanDepartment of General Medicine Tottori Municipal Hospital Tottori‐City Tottori JapanDepartment of General Medicine Tottori Municipal Hospital Tottori‐City Tottori JapanDepartment of General Medicine Tottori Municipal Hospital Tottori‐City Tottori JapanDepartment of General Medicine Tottori Municipal Hospital Tottori‐City Tottori JapanDepartment of General Medicine Tottori Municipal Hospital Tottori‐City Tottori JapanDepartment of General Medicine Tottori Municipal Hospital Tottori‐City Tottori JapanDepartment of General Medicine Tottori Municipal Hospital Tottori‐City Tottori JapanDepartment of General Medicine Tottori Municipal Hospital Tottori‐City Tottori JapanCenter for Community Medicine Jichi Medical University Shimotsuke‐City Tochigi JapanCenter for Community Medicine Jichi Medical University Shimotsuke‐City Tochigi JapanAbstract An 81‐year‐old woman with a history of hypertension and Alzheimer's disease presented to the emergency department because of impaired consciousness. Physical examination revealed acute progressive generalized flaccid paralysis, hypertension, respiratory failure, and pupillary dilation. Although the patient did not complain of headache, head magnetic resonance angiography and magnetic resonance imaging showed multifocal segmental cerebral vasospasm and cerebral infarction in the left occipital lobe. Her family reported that although she did not have a license to cook pufferfish, she was in the habit of eating pufferfish. We subsequently detected tetrodotoxin in the patient's urine, and she was diagnosed with tetrodotoxin poisoning. As the symptoms of tetrodotoxin intoxication improved, head magnetic resonance angiography showed the disappearance of the multifocal segmental cerebral vasospasm. The patient's clinical course and imaging findings were consistent with reversible cerebral vasoconstriction syndrome (RCVS). Sympathetic overactivity after tetrodotoxin intoxication possibly caused the development of RCVS, and RCVS could not be ruled out even in the absence of the typical thunderclap headache. Magnetic resonance angiography is a useful modality when performing repeated examinations.https://doi.org/10.1002/emp2.12627ischemic strokemagnetic resonance angiographymultifocal segmental cerebral artery vasoconstrictionpufferfishreversible cerebral vasoconstriction syndromesympathetic over‐activity |
| spellingShingle | Eiichi Kakehi Makoto Matsumoto Shohei Taniguchi Yukinobu Akamatsu Shigehisa Sakurai Akane Hirotani Takafumi Nozaki Keisuke Shoji Seiji Adachi Kazuhiko Kotani Masami Matsumura Reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning: A case report Journal of the American College of Emergency Physicians Open ischemic stroke magnetic resonance angiography multifocal segmental cerebral artery vasoconstriction pufferfish reversible cerebral vasoconstriction syndrome sympathetic over‐activity |
| title | Reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning: A case report |
| title_full | Reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning: A case report |
| title_fullStr | Reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning: A case report |
| title_full_unstemmed | Reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning: A case report |
| title_short | Reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning: A case report |
| title_sort | reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning a case report |
| topic | ischemic stroke magnetic resonance angiography multifocal segmental cerebral artery vasoconstriction pufferfish reversible cerebral vasoconstriction syndrome sympathetic over‐activity |
| url | https://doi.org/10.1002/emp2.12627 |
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