Intracerebral Hemorrhages Secondary to Reversible Cerebral Vasoconstriction Syndrome: Case Report and Literature Review

Abstract

Reversible cerebral vasoconstriction syndrome is an unusual entity, characterized by recurrent thunderclap headache and segmental narrowing of the cerebral arteries, typically with remission within three months. It has been described since the 1960s with several names, including Call-Fleming syndrome. More than 500 cases have been described in the literature, yet the pathophysiology remains not well understood. Ischemic or hemorrhagic strokes are the major possible complications of the syndrome, leading to permanent neurological deficits or death in a small percentage of patients. We report a case of a 48-year-old female patient without known risk factors that presented two foci of intracerebral hemorrhages, with hemiparesis ipsilateral to the biggest intracerebral lesion. Magnetic resonance imaging tractography revealed normal pyramidal decussation, and the patient evolved with completely recover of the neurological deficit within a week. The authors believe that in the present case neurological deficit may be related to contralateral narrowing of the cerebral arteries and diffuse impairment of the central nervous system instead of intracerebral hemorrhage itself. RCVS is a rare condition that should be considered in patients with recurrent thunderclap type headache. Further prospective and randomized studies are still necessary to improve the management and treatment of patients with the syndrome.