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Case report
Reversible cerebral vasoconstriction syndrome during caesarean section
  1. Szilard Laszlo Safran1,2,
  2. Christian Balmer1 and
  3. Georges Savoldelli2,3
  1. 1Service d'anesthésiologie et de réanimation du CHVR, Hopital du Valais, Sion, Switzerland
  2. 2Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
  3. 3Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
  1. Correspondence to Professor Georges Savoldelli; Georges.savoldelli{at}hcuge.ch

Abstract

We describe the case of a 25-year-old parturient who presented sudden onset and short-lived severe headache caused by reversible cerebral vasoconstriction syndrome (RCVS) during an emergency caesarean section. The syndrome was triggered by phenylephrine administered intravenously to correct arterial hypotension following spinal anaesthesia. RCVS is a clinical and radiological syndrome attributed to transient disturbance in the control of cerebral arterial tone resulting in vasospasms. The syndrome can be precipitated by several triggers, including vasoactive drugs, often used during spinal anaesthesia, illicit drugs, pregnancy and postpartum state. Diagnosis and management can be challenging during pregnancy, peripartum or post partum, since many medications commonly used during these periods must be avoided to prevent triggering RCVS. The aim of this report is to raise the awareness, particularly for anaesthesiologists and obstetricians, of this rare and potentially serious syndrome. We discuss diagnosis, triggers, pathogenesis, clinical course and complications, as well as coordinated multidisciplinary management plans.

  • anaesthesia
  • neurology (drugs and medicines)
  • obstetrics, gynaecology and fertility
  • headache (including migraines)
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Footnotes

  • Contributors SLS wrote the initial draft of the article and contributed to the revisions. CB and GS contributed to the initial conception and writing of the article and made several revisions of the paper. All authors approved the final manuscript for publication.

  • 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 Obtained.

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

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