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A Pediatric Case of Reversible Segmental Cerebral Vasoconstriction

Published online by Cambridge University Press:  02 December 2014

Adam Kirton ,
John Diggle ,
William Hu  and
Elaine Wirrell
Adam Kirton*
Affiliation:
Department of Pediatrics, Divisions of Pediatric Neurology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
John Diggle
Affiliation:
Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
William Hu
Affiliation:
Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
Elaine Wirrell
Affiliation:
Department of Pediatrics, Divisions of Pediatric Neurology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
*
Pediatric Stroke Program, Division of Neurology, Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada
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Abstract:

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Background:

Reversible segmental cerebral vasoconstriction (RSCV) is a recognizable clinical and radiographic syndrome consisting of thunderclap headache with or without focal neurological symptoms combined with reversible segmental vasoconstriction of proximal cerebral blood vessels.

Methods:

We report a case of reversible segmental cerebral vasoconstriction in a child.

Results:

A healthy 13-year-old boy experienced the sudden onset of a severe, diffuse headache upon surfacing from a deep dive in a swimming pool. Severity was maximal at the onset and improved over several hours. The same headache recurred three times over the next four days and a low baseline headache persisted throughout. Vomiting occurred once and mild photo/osmophobia were reported but throbbing, aura, or autonomic symptoms were absent. Focal neurological signs or symptoms were absent and he denied previous history of headaches, medications, drugs, or trauma. Two normal CT scans were performed within hours of separate headaches. Cerebrospinal fluid study on day 5 was bloody with no xanthochromia. MRI/MRA/MRV of the brain and vasculitic work-up were normal. Cerebral angiography on day 6 demonstrated smooth narrowing of multiple proximal cerebral vessels including supraclinoid internal carotid artery (ICA), M1, and A1 on the right and M1 on the left. By ten days, the patient's headaches had resolved and repeat angiography was normal.

Conclusion:

RSCV should be considered in a child with thunderclap headache.

Résumé:

RÉSUMÉ: Contexte:

La vasoconstriction cérébrale segmentaire réversible (VCSR) est un syndrome clinique et radiologique reconnaissable, caractérisé par une céphalée en coup de tonnerre avec ou sans symptômes neurologiques focaux, associé à une vasoconstriction segmentaire réversible des vaisseaux sanguins cérébraux proximaux.

Méthodes:

Nous rapportons une observation de VCSR chez un enfant.

Résultats:

Un garçon de 13 ans, en bonne santé, a ressenti subitement une céphalée diffuse, sévère, en arrivant à la surface de l’eau après avoir effectué un plongeon en profondeur dans une piscine. La sévérité était maximale au début de la céphalée et a diminué dans les heures qui ont suivi. La même céphalée est réapparue trois fois au cours des quatre jours suivants sur un fond de céphalée persistante moins intense. Il a vomi une fois et il éprouvait une légère photo/osmophobie, sans douleur pulsatile aura ou symptômes au niveau du système nerveux autonome. Il n’avait pas de signes ou de symptômes neurologiques focaux et aucune histoire de céphalée antérieure ou de traumatisme, de prise de médicaments ou drogues. La tomodensitométrie effectuée dans les heures qui ont suivi deux épisodes différents de céphalée s’est avérée normale. Le liquide céphalo-rachidien prélevé au cinquième jour était sanglant, mais sans xanthochromie. L’IRM/ARM/VRM du cerveau et le bilan effectué pour déterminer s’il s’agissait d’une vasculite étaient normaux. L’angiographie cérébrale effectuée le sixième jour a montré un rétrécissement lisse de plusieurs vaisseaux cérébraux proximaux dont l’ACI, la M1 et l’A1 du côté droit et la M1 du côté gauche. La céphalée a disparu après dix jours et l’angiographie de contrôle était normale.

Conclusion:

La VCSR devrait faire partie du diagnostic différentiel de la céphalée en coup de tonnerre chez l’enfant.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 2 , May 2006 , pp. 250 - 253
Copyright
Copyright © The Canadian Journal of Neurological 2006

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