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Reversible Cerebral Vasoconstriction Syndrome in a Previously Healthy Child: A Case Report
Ana Rute Manuel1, Carolina Gonçalves1, Adriana Silva1
1Child and Youth Department (A.R.M., C.G., A.S., C.L.), Hospital Professor Doutor Fernando Fonseca; Pediatric Intensive Care Unit (C.E.), Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal; and Neuroradiology Unit (R.M.), Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
Insights
A boy with reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES) recovered fully after treatment. This case highlights the link between RCVS and PRES, crucial for diagnosing severe headaches.
Area of Science:
- Neurology
- Radiology
Background:
- Reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES) are distinct neurological conditions.
- Understanding the co-occurrence of RCVS and PRES is essential for effective patient management.
Observation:
- A 9-year-old boy presented with symptoms of PRES, including seizures and hypertension.
- Subsequent MRI revealed diffuse cerebral vasoconstriction consistent with RCVS.
- The patient experienced complete symptom resolution and normalization of blood pressure with nimodipine treatment.
Findings:
- This case demonstrates a direct link between RCVS and PRES in a pediatric patient.
- MR angiography was critical in diagnosing the diffuse cerebral vasoconstriction characteristic of RCVS.
- The patient showed no recurrence of symptoms during a 12-month follow-up period.
Implications:
- RCVS and PRES should be considered in the differential diagnosis of severe headaches, especially when accompanied by neurological deficits.
- Early and accurate diagnosis using advanced imaging like MR angiography is vital for prompt and effective treatment.
- This case underscores the importance of recognizing the potential co-occurrence and interplay between RCVS and PRES.
Objectives:
We describe the case of a healthy boy diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES).
Methods:
He was identified after presenting in the emergency department (ED). A review of the 5 previous cases of RCVS complicated with PRES reported in the literature was performed.
Results:
A 9-year-old boy was brought to the ED for intense, throbbing headache and vomiting. Physical and neurologic examinations were normal. Brain CT and CSF examination were unremarkable, and he was discharged after symptomatic relief. Five days later, he returned to the ED for generalized tonic-clonic seizures that ceased with levetiracetam. MRI with angiography showed PRES. Systolic hypertension refractory to therapy was documented. New-onset fluctuating right-sided paresis and paresthesia appeared, so MRI was repeated, showing diffuse cerebral vasoconstriction suggesting RCVS. Nimodipine was started with complete resolution of symptoms and normalization of blood pressure. Four weeks after discharge, TD and MRI showed total vasospasm resolution. There was no recurrence in 12-month follow-up.
Discussion:
This case emphasizes the interconnection between RCVS and PRES, highlighting the need to include both as differential diagnoses for severe headache and the essential role of MR angiography in the investigation.
