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Rare disease
Case report
Reversible cerebral vasoconstriction syndrome (RCVS) caused by over-the-counter calcium supplement ingestion
  1. Adam Ross Schertz1,
  2. Anand Karthik Sarma2,
  3. Sudhir Datar2 and
  4. Peter John Miller1,3,4
  1. 1Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
  2. 2Department of Neurology, Section on Neurocritical Care, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
  3. 3Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  4. 4Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Peter John Miller; pemiller{at}wakehealth.edu

Abstract

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.

  • drugs and medicines
  • adult intensive care
  • drugs: CNS (not psychiatric)
  • neurological injury
  • stroke

https://doi.org/10.1136/bcr-2019-233877

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    Footnotes

    • Contributors ARS took the lead in writing the manuscript. All authors provided critical feedback and helped shape the analysis and manuscript. AKS and SD provided expertise in neurology and neurocritical care, reviewed and interpreted imaging findings and assisted in the editing process. PJM was heavily involved in the planning and design of the manuscript; he also provided expertise in critical care and assisted with the editing process.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Next of kin consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.