CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(03): 764-767
DOI: 10.1055/s-0041-1735923
Case Report

Postpartum Reversible Cerebral Vasoconstriction Syndrome Presenting with Radiological Plethora

Manisha Sharma
1   Department of Neurology, Apollo Speciality Hospital, Nellore, Andhra Pradesh, India
,
Bindu Menon
1   Department of Neurology, Apollo Speciality Hospital, Nellore, Andhra Pradesh, India
,
Gayatri Manam
2   Department of Radiology, Apollo Speciality Hospital, Nellore, Andhra Pradesh, India
› Author Affiliations

Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) is a clinicoradiological syndrome characterized by segmental vasoconstriction of cerebral arteries with resolution in most patients within 1 to 3 months. It has been known to be a benign uniphasic reversible illness but cases of fulminant RCVS with mortality have also been reported. The symptoms can be varied with presentations like transient ischemic attack (TIA), ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and posterior reversible encephalopathy syndrome (PRES). We report a postpartum female with RCVS with radiological features of ICH, SAH, atypical PRES, and atypical clinical presentation as well. RCVS can be frequently missed unless there is a high index of suspicion. Hence clinicians should be aware of the typical and the atypical presentation of RCVS along with the radiological findings with the potential complications. Early suspicion and detection in the emergency help in recovery and reducing morbidity.



Publication History

Article published online:
06 October 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible cerebral vasoconstriction syndrome, part 1: epidemiology, pathogenesis, and clinical course. AJNR Am J Neuroradiol 2015; 36 (08) 1392-1399
  • 2 Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med 2007; 146 (01) 34-44
  • 3 Skeik N, Porten BR, Kadkhodayan Y, McDonald W, Lahham F. Postpartum reversible cerebral vasoconstriction syndrome: review and analysis of the current data. Vasc Med 2015; 20 (03) 256-265
  • 4 Akhter T, Larsson A, Larsson M, Wikström AK, Naessen T. Artery wall layer dimensions during normal pregnancy: a longitudinal study using noninvasive high-frequency ultrasound. Am J Physiol Heart Circ Physiol 2013; 304 (02) H229-H234
  • 5 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): 3091-3101
  • 6 Mawet J, Boukobza M, Franc J. et al. Reversible cerebral vasoconstriction syndrome and cervical artery dissection in 20 patients. Neurology 2013; 81 (09) 821-824
  • 7 Chen SP, Fuh JL, Lirng JF, Wang YF, Wang SJ. Recurrence of reversible cerebral vasoconstriction syndrome: a long-term follow-up study. Neurology 2015; 84 (15) 1552-1558
  • 8 Wolff V, Ducros A. Reversible cerebral vasoconstriction syndrome without typical thunderclap headache. Headache 2016; 56 (04) 674-687
  • 9 Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol 2012; 11 (10) 906-917
  • 10 Aracki-Trenkić A, Stojanov D, Trenkić M. et al. Atypical presentation of posterior reversible encephalopathy syndrome: clinical and radiological characteristics in eclamptic patients. Bosn J Basic Med Sci 2016; 16 (03) 180-186
  • 11 Singhal AB, Hajj-Ali RA, Topcuoglu MA. et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 2011; 68 (08) 1005-1012
  • 12 McKinney AM, Jagadeesan BD, Truwit CL. Central-variant posterior reversible encephalopathy syndrome: brainstem or basal ganglia involvement lacking cortical or subcortical cerebral edema. AJR Am J Roentgenol 2013; 201 (03) 631-638
  • 13 McKinney AM, Short J, Truwit CL. et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 2007; 189 (04) 904-912
  • 14 Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible cerebral vasoconstriction syndrome, part 2: diagnostic work-up, imaging evaluation, and differential diagnosis. AJNR Am J Neuroradiol 2015; 36 (09) 1580-1588