Article ID: 10627
A 56-year-old woman experienced a sudden episode of severe headache and left motor weakness. Her past medical history is untreated hypertension. On admission, a CT scan revealed convexal subarachnoid hemorrhage. Brain diffusion-weighted MR images revealed infarction at the same region as the territory of right anterior cerebral artery. Cerebral angiography showed multifocal segmental vasoconstriction of anterior and posterior cerebral arteries. During conservative treatment including calcium antagonist and cilostazol, new neurological deficit was not observed. However, segmental stenosis of the anterior cerebral artery improved once, and then progressed. MR angiography showed that the stenosis was almost completely relieved 2 weeks after onset of severe headache. Her left hemiparesis had completely recovered on the fourth week after the onset. She was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) by the radiographical findings and clinical courses. We should mind that RCVS exhibited both subarachnoid hemorrhage and cerebral infarction at an early onset.
