Unique combination of hyperintense vessel sign on initial FLAIR and delayed vasoconstriction on MRA in reversible cerebral vasoconstriction syndrome: A case report. (November 2014)

• Record Type: Journal Article
• Authors: Kameda, Tomoaki; Namekawa, Michito; Shimazaki, Haruo; Minakata, Daisuke; Matsuura, Tohru; Nakano, Imaharu
• Is Part Of: Cephalalgia. Volume 34:Number 13(2014)
• Page Start: 1093
• Page End: 1096
• Publication Date: 2014-11
• Subjects: Thunderclap headache -- hyperintense vessel sign -- reversible cerebral vasoconstriction syndrome; Headache -- Periodicals; 616.8491
• DOI: 10.1177/0333102414529197
• Languages: English
• ISSNs: 0333-1024

Abstract

Background: Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache and reversible cerebral vasoconstriction on angiographic findings. It can be difficult to diagnose when initial angiography is normal. Case results: A 30-year-old woman was admitted because of sudden-onset thunderclap headache and seizure on postpartum day 7. Brain MRI on fluid-attenuated inversion recovery (FLAIR) showed hyperintense vessel sign (HVS), which usually means slow flow due to severe proximal arterial stenosis. However, magnetic resonance angiography (MRA) indicated that proximal arteries was normal. After nicardipine treatment, her symptoms improved dramatically. Follow-up FLAIR on day 7 showed complete resolution of HVS, while a series of MRAs revealed reversible multifocal segmental vasoconstriction. Conclusions: HVS on initial FLAIR is useful for an early diagnosis of reversible cerebral vasoconstriction syndrome. As the delayed vasoconstriction on MRA can be observed, reversible cerebral vasoconstriction syndrome may progress from distal small to proximal larger arteries.