Cortical subarachnoid haemorrhage with reversible cerebral vasoconstriction syndrome in an elderly woman

Description

A woman aged 65 years had a sudden onset of severe headache after swimming. She had prolonged headache; therefore, she presented at the emergency department. During the examination in the emergency department, her physical and neurological examinations were unremarkable. Haematological findings were normal. The CT scan of the head revealed a cortical subarachnoid haemorrhage (cSAH) in the right frontal and left temporal lesion (figure 1A, B). The cerebrospinal fluid analysis revealed normal protein and cell counts. A brain MRI showed only high-intensity changes for cSAH with no findings of microbleeds (figure 1C, D). The magnetic resonance angiography (MRA) showed mild stenotic changes on the right posterior cerebral artery (PCA) (figure 2A). There was no evidence of any aneurysm. Based on the constriction findings, reversible cerebral vasoconstriction syndrome (RCVS) in conjunction with cSAH was suspected, and intravenous nicardipine was initiated followed by...

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