PMC5505916_01
Clinical course. The patient complained of amnesia and headache on admission and subsequently a thunderclap headache on day 9. His headache disappeared on day 13, but a brain MRI on day 14 showed segmental vasoconstriction of the cerebral arteries. A brain MRI on day 21 showed new areas of infarction, and he was started on oral verapamil 240 mg/day and edaravone 60 mg/day. A brain MRI on day 29 showed resolution of the segmental vasoconstriction. He was discharged directly home on oral verapamil on day 30.
1349-7235-56-1569-g001.jpg
PMC5505916_01_1349-7235-56-1569-g001.jpg
g001
His clinical course is shown in Fig. 1.
Brain magnetic resonance angiography. (A) Magnetic resonance angiography (MRA) of a 65-year-old man with reversible cerebral vasoconstriction syndrome on day 2 showing segmental constriction of the right posterior cerebral artery (PCA) (arrow head). (B) MRA showing segmental constriction of the right vertebral artery (VA), bilateral PCA, bilateral middle cerebral artery (MCA) and left anterior cerebral artery (ACA) (arrow heads) on day 15. (C) MRA showing resolution of the segmental vasoconstriction on day 22.
1349-7235-56-1569-g002.jpg
PMC5505916_01_1349-7235-56-1569-g002.jpg
g002
However MRA revealed multifocal segmental narrowing of the right vertebral artery (VA), bilateral posterior cerebral artery (PCA), bilateral middle cerebral artery (MCA) and left anterior cerebral artery (ACA) (Fig. 2A). MRI showed new areas of ischemia in the left upper occipital region (Fig. 3B-D). MRA showed persistent multifocal irregular stenosis of the right VA, bilateral PCA, bilateral MCA and left ACA, which was consistent with vasoconstriction (Fig. 2B). On day-22, brain MRA showed the resolution of the segmental vasoconstriction (Fig. 2C).
Computed tomography (CT) on day 9 and magnetic resonance imaging (MRI) on day 21. (A) On day 9, CT showing left frontal subarachnoid hemorrhage. (B) On day 21, Fluid Attenuated Inversion Recovery (FLAIR), (C) diffusion-weighted MRI, and (D) apparent diffusion coefficient maps revealed lesions in the left parietal lobe consistent with infarction.
1349-7235-56-1569-g003.jpg
PMC5505916_01_1349-7235-56-1569-g003.jpg
g003
Brain computed tomography (CT) scanning on day-9 demonstrated a subarachnoid hemorrhage over the left frontal convexity (Fig. 3A) and CT angiography demonstrated no improvement of the segmental stenosis. MRI showed new areas of ischemia in the left upper occipital region (Fig. 3B-D). MRA showed persistent multifocal irregular stenosis of the right VA, bilateral PCA, bilateral MCA and left ACA, which was consistent with vasoconstriction (Fig. 2B).