A non-traumatic, rapid-onset headache that is as dangerous as subarachnoid hemorrhage (SAH) seen in the emergency department

被引:1
|
作者
Palilonis, Matthew M. [1 ]
Jacoby, Jeanne L. [1 ]
机构
[1] Lehigh Valley Hlth Network, Dept Emergency & Hosp Med, Bethlehem, PA 18017 USA
来源
关键词
D O I
10.1016/j.ajem.2018.05.071
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
A 36yo male with multiple non-traumatic, rapid-onset headaches had Emergency Department visits on days 3 and 10 after onset of symptoms. He is a social smoker and drinker. CT head imaging was negative. An MRI/MRA was obtained. The image represents multiple foci of vasoconstriction and dilation in medium and large cerebral vessels consistent with Reversible Cerebral Vasoconstriction Syndrome (RCVS). Multiple rapid-onset headaches and "string of beads" on MRA imaging are pathognomonic for RCVS, which has a 4:1 female to male ratio. Manifestations include the pure cephalic form, characterized by a headache; subarachnoid hemorrhage and cerebral infarction have also been reported. Vasoactive drugs and the post-partum period are recognized as common inciting events. Symptoms usually resolve in 3-6 months. Treatment with nimodipine, 1-2mg/kg/hr IV and/or 30-60mg PO QID orally over 4-8 weeks, has been reported to be effective. (C) 2018 Elsevier Inc. All rights reserved.
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