Reversible cerebral vasoconstriction syndrome revealed by fronto-callosal infarctions
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LETTER TO THE EDITOR
Reversible cerebral vasoconstriction syndrome revealed by fronto‑callosal infarctions Céline Bouvy1 · Nathalie Ackermans1 · Sofia Maldonado Slootjes1 · Matthieu Pierre Rutgers1 · Michel Gille1 Received: 8 October 2019 / Accepted: 27 February 2020 © Belgian Neurological Society 2020
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches and vasoconstriction of cerebral arteries which resolves spontaneously in less than 3 months. Recurrent thunderclap headache is the main clinical presentation. Major complications occur such as localized cortical subarachnoidal hemorrhages in less than 25% of the cases and parenchymal strokes in less than 10% [1]. We report on a patient with fronto-callosal infarctions as an unusual complication of RCVS without evidence of thunderclap headaches. A left-handed 52-year-old woman presented with a right brachiofacial hemiparesis for 24 h. She was a regular consumer of cannabis and was known with tension headache, cervical discopathy, and chronic depression treated with venlafaxine. She complained of mild non pulsatile diffuse headaches. On neurological examination, there was an extension of the right cutaneous plantar response with diffuse tendon hyperreflexia. The magnetic resonance imaging (MRI) showed on DWI acute infarctions in the left paramedian frontal lobe and in all the corpus callosum, from the rostrum to the splenium (Fig. 1) Angiographic computerized (CTA) and angio-MRI studies revealed a stenosis in the A1 segment of the right cerebral artery, occlusions of the A2 segment of both anterior cerebral arteries and in the M1/ M2 junction of the left middle cerebral artery, a stenosis of * Michel Gille [email protected] Céline Bouvy [email protected] Nathalie Ackermans [email protected] Sofia Maldonado Slootjes [email protected] Matthieu Pierre Rutgers [email protected] 1
Department of Neurology, Europe Hospitals, 206 Avenue de Fré, 1180 Brussels, Belgium
the M1/M2 junction of the right middle cerebral artery, and a very thin pericallosal artery (Fig. 2a–c). One day later, the right hemiparesis had recovered and unvoluntary movements of the right hand appeared, as impulsive reaching and groping movements in her hair. This movement disorder was interpreted as a frontal alien hand syndrome. Cognitive tests also demonstrate a loss of spontaneous language, fluctuating dysarthria, dysorthographia, agraphia, and executive dysfunctions. Total and LDL cholesterol serum levels were respectively increased at 3.1 g/L and 2.3 g/L. Autoimmune and infectious serologies were negative. Coagulation tests were normal. Carotid artery ultrasound Doppler, transoesophagal echocardiography, and 24 h ECG-Holter were unremarkable. She was treated with clopidogrel (75 mg/day) and atorvastatine (40 mg/day). Two weeks later, the movement disorder had disappeared and the selective cerebral arteriography was normalized (Fig. 2d, e). The reversibility of the angiographic findings led us to
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