Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytoma
We report the case of a 76-year-old male with a remote history of papillary thyroid cancer who developed severe paroxysmal headaches in the setting of episodic hypertension. Brain imaging revealed multiple lesions, initially of inconclusive etiology, but suspicious for metastatic foci. A search for...
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| Format: | Article |
| Language: | English |
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Bioscientifica
2020-08-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2020/1/EDM20-0078.xml |
| _version_ | 1818315833445711872 |
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| author | Jai Madhok Amy Kloosterboer Chitra Venkatasubramanian Frederick G Mihm |
| author_facet | Jai Madhok Amy Kloosterboer Chitra Venkatasubramanian Frederick G Mihm |
| author_sort | Jai Madhok |
| collection | DOAJ |
| description | We report the case of a 76-year-old male with a remote history of papillary thyroid cancer who developed severe paroxysmal headaches in the setting of episodic hypertension. Brain imaging revealed multiple lesions, initially of inconclusive etiology, but suspicious for metastatic foci. A search for the primary malignancy revealed an adrenal tumor, and biochemical testing confirmed the diagnosis of a norepinephrine-secreting pheochromocytoma. Serial imaging demonstrated multiple cerebral infarctions of varying ages, evidence of vessel narrowing and irregularities in the anterior and posterior circulations, and hypoperfusion in watershed areas. An exhaustive work-up for other etiologies of stroke including thromboembolic causes or vasculitis was unremarkable. There was resolution of symptoms, absence of new infarctions, and improvement in vessel caliber after adequate alpha-adrenergic receptor blockade for the management of pheochromocytoma. This clinicoradiologic constellation of findings suggested that the etiology of the multiple infarctions was reversible cerebral vasoconstriction syndrome (RCVS). Pheochromocytoma remains a poorly recognized cause of RCVS. Unexplained multifocal cerebral infarctions in the setting of severe hypertension should prompt the consideration of a vasoactive tumor as the driver of cerebrovascular dysfunction. A missed or delayed diagnosis has the potential for serious neurologic morbidity for an otherwise treatable condition. |
| first_indexed | 2024-12-13T09:11:49Z |
| format | Article |
| id | doaj.art-9d6c2dbfd13143af827795ca80c9b00a |
| institution | Directory Open Access Journal |
| issn | 2052-0573 2052-0573 |
| language | English |
| last_indexed | 2024-12-13T09:11:49Z |
| publishDate | 2020-08-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-9d6c2dbfd13143af827795ca80c9b00a2022-12-21T23:52:54ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732052-05732020-08-01111610.1530/EDM-20-0078Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytomaJai Madhok0Amy Kloosterboer1Chitra Venkatasubramanian2Frederick G Mihm3Department of Anesthesiology, Perioperative and Pain MedicineDepartment of Anesthesiology, Perioperative and Pain MedicineDepartment of Neurology & Neurological Sciences, Stanford University Medical Center, Stanford, California, USADepartment of Anesthesiology, Perioperative and Pain MedicineWe report the case of a 76-year-old male with a remote history of papillary thyroid cancer who developed severe paroxysmal headaches in the setting of episodic hypertension. Brain imaging revealed multiple lesions, initially of inconclusive etiology, but suspicious for metastatic foci. A search for the primary malignancy revealed an adrenal tumor, and biochemical testing confirmed the diagnosis of a norepinephrine-secreting pheochromocytoma. Serial imaging demonstrated multiple cerebral infarctions of varying ages, evidence of vessel narrowing and irregularities in the anterior and posterior circulations, and hypoperfusion in watershed areas. An exhaustive work-up for other etiologies of stroke including thromboembolic causes or vasculitis was unremarkable. There was resolution of symptoms, absence of new infarctions, and improvement in vessel caliber after adequate alpha-adrenergic receptor blockade for the management of pheochromocytoma. This clinicoradiologic constellation of findings suggested that the etiology of the multiple infarctions was reversible cerebral vasoconstriction syndrome (RCVS). Pheochromocytoma remains a poorly recognized cause of RCVS. Unexplained multifocal cerebral infarctions in the setting of severe hypertension should prompt the consideration of a vasoactive tumor as the driver of cerebrovascular dysfunction. A missed or delayed diagnosis has the potential for serious neurologic morbidity for an otherwise treatable condition.https://edm.bioscientifica.com/view/journals/edm/2020/1/EDM20-0078.xml |
| spellingShingle | Jai Madhok Amy Kloosterboer Chitra Venkatasubramanian Frederick G Mihm Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytoma Endocrinology, Diabetes & Metabolism Case Reports |
| title | Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytoma |
| title_full | Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytoma |
| title_fullStr | Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytoma |
| title_full_unstemmed | Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytoma |
| title_short | Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytoma |
| title_sort | catecholamine induced cerebral vasospasm and multifocal infarctions in pheochromocytoma |
| url | https://edm.bioscientifica.com/view/journals/edm/2020/1/EDM20-0078.xml |
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