BMJ Case Reports 2012; doi:10.1136/bcr.09.2011.4841
  • Rare disease

A reversible cerebral vasoconstriction syndrome

  1. Maher Saqqur
  1. Division of Neurology, University of Alberta, Edmonton, Canada
  1. Correspondence to Maher Saqqur, maher.saqqur{at}


Reversible cerebral vasoconstriction syndrome (RCVS) is typically presented with severe headaches where, vascular imaging demonstrates multiple intracranial arterial narrowing. Variable triggers are related to RCVS, such as serotonin agents and bromocriptine. Thus, a detailed medication history is important. Subarachnoid haemorrhage (SAH) is not uncommon in RCVS. Repeat vascular imaging at 2–3 months with complete reversal of the narrowed vessels confirms the diagnosis of RCVS.

The authors present a case where use of triptan along with multiple psychotropic medications, was associated with RVCS. Neuroimaging demonstrated focal SAH and diffuse beaded appearance involving the intracranial vasculature. The patient improved clinically with oral nimodipine treatment. Repeat angiography and a follow-up transcranial Doppler showed complete resolution of vasoconstriction.

In the setting of acute severe headache, with any ‘red flags’, it is important to evaluate the medication use and other precipitating risks for RVCS. Vascular imaging is the key for diagnosis.


  • Competing interests None.

  • Patient consent Obtained.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article