Reversible cerebral vasoconstriction syndrome (RCVS) caused by over-the-counter calcium supplement ingestion

2021 ◽  
Vol 14 (1) ◽  
pp. e233877 ◽  
Author(s):  
Adam Ross Schertz ◽  
Anand Karthik Sarma ◽  
Sudhir Datar ◽  
Peter John Miller
Keyword(s):  
Serum Calcium ◽  
Pressure Control ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Albumin Concentration ◽  
Herbal Supplements ◽  
Over The Counter ◽  
Cerebral Angiogram ◽  
Cerebral Vasoconstriction ◽  
Ct Angiogram ◽  
Chronic Ingestion

A 59-year-old woman was found unresponsive at home. Initial neurologic examination revealed aphasia and right-sided weakness. Laboratory results demonstrated a serum calcium level of 17.3 mg/dL (corrected serum calcium for albumin concentration was 16.8 mg/dL). Extensive workup for intrinsic aetiology of hypercalcemia was unrevealing. Further discussion with family members and investigation of the patient’s home for over-the-counter medications and herbal supplements revealed chronic ingestion of calcium carbonate tablets. CT angiogram of the brain revealed multifocal intracranial vascular segmental narrowing, which resolved on a follow-up cerebral angiogram done 2 days later. These findings were consistent with reversible cerebral vasoconstriction syndrome.Appropriate blood pressure control with parenteral agents, calcium channel blockade with nimodipine and supportive care therapies resulted in significant improvement in neurologic status. By discharge, patient had near-complete resolution of neurologic symptoms.

Reversible cerebral vasoconstriction syndrome

2020 ◽  
pp. 447-456
Author(s):  
Aneesh B. Singhal
Keyword(s):  
Drug Use ◽  
Sexual Activity ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Over The Counter ◽  
Cerebral Vasoconstriction ◽  
Intracranial Arteries

Reversible cerebral vasoconstriction syndrome (RCVS) is a term used to describe a group of conditions characterized by reversible segmental narrowing and dilatation of multiple intracranial arteries. Most patients present with an explosive-onset, severe (thunderclap) headache. Thunderclap headaches frequently recur over days to weeks. Recent studies suggest that RCVS and primary thunderclap headache belong to the same spectrum of disorders, justifying the inclusion of RCVS in this textbook of headache syndromes. Up to one-third of patients do not have any identifiable trigger; however, most cases have been associated with exposure to vasoconstrictive medications, illicit drug use, over-the-counter agents, sexual activity, and childbirth.

B-01 Cognitive Deficits Following Hemorrhagic Stroke in Reversible Cerebral Vasoconstriction Syndrome: A Case Study

2019 ◽  
Vol 34 (6) ◽  
pp. 944-944
Author(s):  
E Schultz ◽  
S DeDios-Stern ◽  
G Ovsiew ◽  
N Pliskin
Keyword(s):  
Hemorrhagic Stroke ◽  
Case Reports ◽  
Cerebral Arteries ◽  
Rare Condition ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Thalamic Lesion ◽  
Neurocognitive Deficits ◽  
Cerebral Angiogram ◽  
Cerebral Vasoconstriction

Abstract Objective Reversible cerebral vasoconstriction syndrome (RCVS), a relatively rare condition presenting as severe thunderclap headache with or without neurological deficits, is characterized by vasoconstriction of cerebral arteries which often resolves within three months and may be associated with stroke. Previous case reports examining neuropsychological profiles of RCVS patients demonstrated stroke-specific and/or diffuse global impairments that often exceed impairment expected post-acute phase of clinical stroke and possibly suggest residual deficits related to RCVS alone (Perdices & Herkes, 2018). Method The present case is a 36-year-old right-handed African-American male who sustained a left thalamic hemorrhage with extension into the ventricular system following marijuana use. Cerebral angiogram was suggestive of RCVS. The Montreal Cognitive Assessment (MoCA), Western Aphasia Battery (WAB), Repeatable Battery for the Assessment of Neuropsychological Status- Update (RBANS), and Peabody Picture Vocabulary Teat- 4th edition (PPVT-4) were administered at bedside. Results Neuropsychological testing was abnormal with severe global impairments on tasks requiring attention and processing speed, visuospatial abilities, immediate and delayed memory, and executive functioning. The patient’s expressive speech was characterized by fluent output with pronounced provoked and unprovoked phonemic and semantic paraphasias. Additionally, he evidenced confabulatory responses during memory testing and lost mental set during tasks requiring simultaneous attention. Conclusions Considering the patients clear sensorium at the time of the evaluation, these deficits extend beyond what would be expected by a single thalamic lesion and implicate more generalized cerebral dysfunction secondary to his RCVS. Consistent with previous case studies, this case demonstrates how RCVS may confound and contribute to neurocognitive deficits even after hemorrhagic stroke.

Herbal Supplements Association with Reversible Cerebral Vasoconstriction Syndrome: A Case Report

2017 ◽  
Vol 26 (3) ◽  
pp. 673-676 ◽  
Author(s):  
Isabel Costa ◽  
Marcelo D. Mendonça ◽  
Vera Cruz e Silva ◽  
Sofia Calado ◽  
Miguel Viana-Baptista
Keyword(s):  
Case Report ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Herbal Supplements ◽  
Cerebral Vasoconstriction

scholarly journals Fulminant Reversible Cerebral Vasoconstriction Syndrome

2017 ◽  
Vol 8 (1) ◽  
pp. NP5-NP8 ◽  
Author(s):  
Kushak Suchdev ◽  
Gregory Norris ◽  
Imad Zak ◽  
Wazim Mohamed ◽  
Mohammed Ibrahim
Keyword(s):  
Computed Tomography ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Cerebral Angiogram ◽  
Young Females ◽  
Cerebral Vasoconstriction ◽  
Insidious Onset ◽  
Show Evidence ◽  
Underlying Disorder ◽  
Poor Outcomes

Reversible cerebral vasoconstriction syndrome (RCVS) is increasingly being recognized as a diagnosis in patients presenting with thunderclap headaches. In the vast majority of the cases, the syndrome follows a benign course and patients recover completely without any significant therapeutic intervention. In the rarest of cases, RCVS follows a monophasic course with rapid worsening, severe neurological deficits, and poor outcomes. We present the case of a 25-year-old female who presented with headaches which were worsening over 1 week. She was admitted to the hospital and rapidly worsened to develop severe neurological deficits over the next day. Initial computed tomography scan showed areas of hemorrhage and multiple ischemic strokes. Computed tomography angiogram and a conventional cerebral angiogram both revealed multifocal vasoconstriction, highly suggestive of RCVS. Despite aggressive medical and surgical management, the patient continued to worsen and eventually died. Autopsy findings did not show evidence of vasculopathy or any other underlying disorder, further supporting the diagnosis of RCVS. The RCVS is usually a benign self-remitting condition which commonly affects young females and presents with an insidious onset of headaches. Rarely, it can have a fulminant course with devastating outcomes. This case illustrates an exceptionally uncommon clinical course of RCVS and the challenges in its treatment.

scholarly journals Reversible Cerebral Vasoconstriction Syndrome: Treatment with Multiple Sessions of Intra-Arterial Nimodipine and Angioplasty

2012 ◽  
Vol 18 (3) ◽  
pp. 297-302 ◽  
Author(s):  
I. Ioannidis ◽  
N. Nasis ◽  
E. Agianniotaki ◽  
E. Katsouda ◽  
A. Andreou
Keyword(s):  
Internal Carotid ◽  
Severe Case ◽  
Neurological Symptoms ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Left Internal Carotid Artery ◽  
Channel Blockers ◽  
Cerebral Angiogram ◽  
Unruptured Aneurysms ◽  
Cerebral Vasoconstriction ◽  
Angiographic Findings

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute severe headache with or without additional neurological symptoms and reversible cerebral vasoconstriction. Unruptured aneurysms have been reported in some cases with RCVS. We describe a severe case of a 50-year-old woman with RCVS presenting as cortical subarachnoid hemorrhage. Cerebral angiogram demonstrated the typical angiographic findings of RCVS and two very small unruptured aneurysms of the left internal carotid artery. The patient was treated with calcium channel blockers and the two aneurysms were successfully treated endovascularly. On day 16 the patient developed new focal neurological symptoms (severe paraparesis) and was successfully treated with intraarterial nimodipine and angioplasty in multiple sessions.

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