Teaching NeuroImages: RCVS causing simultaneous convexity subarachnoid hemorrhage and hemimedullary infarction

A 34-year-old previously healthy man presented with thunderclap headache, dysphagia, dysarthria, and oscillopsia. Neurologic examination revealed right-beating nystagmus, dysphagia, hypophonia, right hemianesthesia, and left hemiparesis. Brain imaging showed convexity subarachnoid hemorrhage (figure 1A) and left hemimedullary infarct (figure 1B). Catheter angiography showed tapering of left vertebral artery and diffuse segmental vasoconstriction (figure 2). Routine serum and CSF results were unremarkable. Thorough infectious, immunologic, and coagulopathy workup was negative. Reversible cerebral vasoconstriction syndrome (RCVS) is associated with severe headache, stroke, brain edema, and hemorrhage characterized by transient, multifocal intracranial vessel vasoconstriction.1 RCVS can cause simultaneous ischemic and hemorrhagic stroke.2

Source: Neurology - September 18, 2017 Category: Neurology Authors: Selvan, P., Levine, S. R. Tags: Stroke in young adults, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke, Infarction, Subarachnoid hemorrhage RESIDENT AND FELLOW SECTION Source Type: research