Abstract
A 44-year-old woman was admitted to the hospital because of thunderclap headache that developed 5 days prior to presentation. Neck stiffness was present, but no neurological deficit was observed. Cortical subarachnoid hemorrhage was noted on performing helical computed tomography. Magnetic resonance (MR) angiography showed multi-focal segmental stenosis of the bilateral middle cerebral arteries. The patient was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS). The headache improved 7 days after onset. However, angiography showed multi-focal segmental stenosis of the bilateral middle cerebral arteries without any other significant abnormality. During conservative treatment, no neurological deficit was observed; however, segmental stenosis of the middle cerebral arteries progressed once, and, then, improved. MR angiography showed that the stenosis was almost completely relieved 1 month after onset of thunderclap headache, and RCVS did not recur.
