A case of reversible cerebral vasoconstriction syndrome presentingas hemorrhagic cerebral infarction

• Published in: Japanese Journal of Stroke Vol. 34; no. 3; pp. 182 - 186
• Main Authors: Ikenaga, Tohru, Tane, Kazuyuki, Ogawa, Ryusuke, Sumioka, Shinya, Yoshihara, Wataru, Nishimura, Shinichi, Doi, Atsushi, Miki, Yoshihito
• Format: Journal Article
• Language: Japanese; English
• Published: The Japan Stroke Society 2012
• Subjects: hemorrhagic infarction; reversible cerebral vasoconstriction syndrome; surgery
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.34.182

A 44 year-old man experienced a sudden episode of a severe headache and left motor weakness while having a quiet smoke. He had in the past a habit of taking cold medicines. On admission, a CT scan revealed subcortical hematoma at the right frontal lobe. Brain diffusion-weighted MR images revealed hemorrhagic infarction at the same region. Cerebral angiography showed multiple vascular irregularities. He was treated conservatively, but right frontal craniotomy and excision of the hematoma was performed eight days after the onset in order to increase the headache and the progression of left sensory disturbance. These symptoms disappeared soon after the surgery. Repeated cerebral angiography five weeks after the onset demonstrated that most of the areas of segmental irregularity had improved. We gave a diagnosis of reversible cerebral vasoconstriction syndrome (RCVS) presenting as hemorrhagic cerebral infarction by the pathological findings and clinical courses. RCVS should be considered as an important differential diagnosis for patients presenting with a sudden onset of a severe headache, if subarachnoid hemorrhage was denied.