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Grief-induced reversible cerebral vasoconstriction syndrome (RCVS)
Pooja Rao1, Michael Francis McCullough2, Jessica Stevens3
1Neurology, Georgetown University Hospital, Washington, DC, USA poojamohanrao@gmail.com.
BMJ Case Reports
|January 31, 2020
Summary
Extreme emotional stress can trigger reversible cerebral vasoconstriction syndrome (RCVS). This case highlights stress as a potential cause of RCVS, leading to severe neurological symptoms and recovery with residual hypersomnia.
Area of Science:
- Neurology
- Neuroscience
- Critical Care Medicine
Background:
- Reversible cerebral vasoconstriction syndrome (RCVS) is increasingly recognized but its triggers remain under-investigated.
- Extreme emotional stress is a potential, yet under-appreciated, precipitant for RCVS.
- The link between psychological distress and cerebrovascular events warrants further clinical attention.
Observation:
- A 46-year-old female with bipolar disorder experienced a severe headache during extreme emotional distress (father's funeral).
- She subsequently developed neurological deficits including hemiparesis, aphasia, and encephalopathy.
- Neuroimaging confirmed a large brain hematoma and subarachnoid hemorrhage.
Findings:
- Cerebral angiograms revealed multifocal cerebral vasoconstriction, consistent with RCVS.
- The patient underwent surgical intervention and recovered significantly over three weeks.
- Follow-up angiography showed resolution of vasoconstriction.
Implications:
- This case underscores the potential link between extreme emotional stress and the onset of RCVS.
- Recognizing stress as a trigger may improve early diagnosis and management of RCVS.
- Further research is warranted to explore the neurobiological mechanisms connecting stress and RCVS.
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