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Case report
Grief-induced reversible cerebral vasoconstriction syndrome (RCVS)
  1. Pooja Rao1,
  2. Michael Francis McCullough2,
  3. Jessica Stevens3 and
  4. Matthew A Edwardson4
  1. 1Neurology, Georgetown University Hospital, Washington, DC, USA
  2. 2Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
  3. 3Neurology, MedStar Washington Hospital Center, Washington, DC, USA
  4. 4Neurology, Georgetown University Medical Center, Washington, DC, USA
  1. Correspondence to Dr Pooja Rao; poojamohanrao{at}gmail.com

Abstract

Stress is under-recognised as a potential causative factor for reversible cerebral vasoconstriction syndrome (RCVS). Here we present a case of RCVS occurring during a time of extreme emotional duress. A 46-year-old female patient with medical history of bipolar disorder developed a severe headache during her father’s funeral. The following day she was discovered to have bilateral hemiparesis, aphasia, encephalopathy and was brought emergently to the hospital. Neuroimaging revealed a 33 mL left fronto-parietal haematoma with subarachnoid blood near the vertex bilaterally. She underwent craniotomy, haematoma evacuation and external ventricular drain placement. The patient received two cerebral angiograms, the first showing multifocal cerebral vasoconstriction and the second showing resolution of these changes. She improved significantly over the course of her 3-week hospitalisation and eventually made a full recovery, including the ability to speak fluently in six languages with no significant deficits other than hypersomnia; she now requires 10 hours of sleep each night as compared with 7 hours prior to her brain injury.

  • neuroimaging
  • coma and raised intracranial pressure
  • headache (including migraines)
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Footnotes

  • Twitter @poojara52867811

  • Contributors PR: she was involved in planning the write up and additional data acquisition. She was also the point of contact for the patient in obtaining follow-up information and consent. MFM: he helped acquire accurate images of the patients angiogram and CT head during hospitalisation. JS: she was involved in editing the article and providing data in the discussion section with important feedback which was helpful. MAE: he was involved in the conception and design of the case report. He made sure all the data were presented in a succinct and precise manner.

  • 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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