Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) usually presents with recurrent thunderclap headaches and is characterized by multifocal and reversible vasoconstriction of cerebral arteries that can sometimes evolve to severe cerebral ischemia and stroke. We describe the case of a patient who presented with a clinically typical RCVS and developed focal neurological symptoms and signs despite oral treatment with calcium channel blockers. Within hours of neurological deterioration, she was treated with intra-arterial milrinone, a phosphodiesterase inhibitor, which resulted in a rapid and sustained neurological improvement.
MeSH terms
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Anti-Inflammatory Agents / therapeutic use
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Brain / blood supply
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Brain / drug effects
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Brain / pathology*
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Calcium Channel Blockers / therapeutic use
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Cerebral Angiography
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Female
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Headache Disorders, Primary / drug therapy*
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Headache Disorders, Primary / etiology
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Headache Disorders, Primary / physiopathology
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Humans
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Infusions, Intravenous
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Magnetic Resonance Imaging
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Middle Aged
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Milrinone / administration & dosage*
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Prednisone / therapeutic use
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Syndrome
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Tomography, X-Ray Computed
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Vasodilator Agents / administration & dosage*
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Vasospasm, Intracranial / complications
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Vasospasm, Intracranial / drug therapy*
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Vasospasm, Intracranial / physiopathology
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Verapamil / therapeutic use
Substances
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Anti-Inflammatory Agents
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Calcium Channel Blockers
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Vasodilator Agents
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Verapamil
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Milrinone
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Prednisone