CORTICAL SUBARACHNOID HEMORRHAGE DUE TO REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME: REPORT OF A CASE AND LITERATURE REVIEW

Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) is an important but often under-recognized cause of cortical subarachnoid hemorrhage (cSAH), characterized by reversible, segmental, multifocal vasospasm of the cerebral arteries, with or without clinical signs. In a number of cases, it coexists with posterior reversible encephalopathy syndrome (PRES). Its prognosis is excellent but other potentially dangerous underlying causes of cSAH should be excluded. We present a 61 year-old woman who was admitted due to migrant tingling sensations in the right half of the body. Brain CT demonstrated a cSAH in the left central sulcus and a diagnosis of amyloid angiopathy was presumed. Follow up MRI one and three months later, revealed a new cSAH in the right hemisphere and vasogenic edema of the occipital lobes. The patient remained asymptomatic and extensive investigations were inconclusive. The neuroimaging findings regressed completely within ten months and no causal factor was identified, thus setting the diagnosis of primary RCVS with concomitant PRES.