Cola-colored Cerebrospinal Fluid: A Case of Reversible Cerebral Vasoconstriction Syndrome

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headache and multifocal cerebral arterial constriction, which can be associated with pregnancy and exposure to certain vasoactive agents. It is usually evoked by triggering agents in 80% of cases. RCVS can present with focal deficits or new-onset seizure in 8-43% and 1-17% of cases, respectively. RCVS is more common than it is thought to be. Thunderclap headaches can persist for a few weeks and occur daily, lasting for 1-3 hours. Potential complications are nonaneurysmal cortical subarachnoid hemorrhage (SAH), lacunar infarcts, posterior reversible encephalopathy syndrome, and intracranial hemorrhage. Diagnosis of RCVS requires a high level of suspicion. The RCVS2 score can be used even before angiographic changes are documented in suspected cases of RCVS. We report a case of a 35-year-old postpartum female patient with RCVS, ischemic stroke, and nonaneurysmal SAH before definite cerebral vasoconstriction documentation.