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Cold-Induced Reversible Cerebral Vasoconstriction Syndrome Presenting With Intraventricular Hemorrhage in a
Layla M Babiker1, Ahmed I Idriss2, Yousif Yousif3
1Internal Medicine, Sudan International University, Khartoum, SDN.
Cureus
|August 4, 2025
Summary
Cold exposure may trigger reversible cerebral vasoconstriction syndrome (RCVS), a rare cause of thunderclap headaches and brain hemorrhage. Early recognition and treatment with calcium channel blockers are crucial for recovery.
Area of Science:
- Neurology
- Neuroscience
- Vascular Neurology
Background:
- Reversible cerebral vasoconstriction syndrome (RCVS) is a neurovascular disorder typically linked to vasoactive substances, stress, or postpartum status.
- Environmental triggers, particularly cold exposure, are infrequently reported causes of RCVS.
Observation:
- A 61-year-old woman experienced a thunderclap headache and vomiting after brief cold weather exposure.
- Initial assessment revealed hypothermia and metabolic acidosis; neuroimaging was deferred.
- Subsequent brain imaging showed intracerebral hemorrhage with intraventricular extension, complicated by anxiety-induced hypertension.
Findings:
- Cerebral vasospasm was identified via CT angiography and digital subtraction angiography, ruling out aneurysms or arteriovenous malformations.
- A diagnosis of RCVS was established, and the patient improved with nimodipine and supportive care.
- The case highlights RCVS in hemorrhagic presentations, even in normotensive individuals.
Implications:
- This case underscores the need to consider RCVS in patients presenting with hemorrhage, irrespective of blood pressure.
- It suggests a potential link between cold-induced autonomic dysregulation and the pathogenesis of RCVS.
- Recognizing uncommon triggers like cold exposure is vital for timely diagnosis and management of RCVS.
Keywords:
cerebral vasospasmcold-induced rcvsintraventricular hemorrhagenormotensive intracerebral hemorrhagereversible cerebral vasoconstriction syndrome (rcvs)thunderclap headacheMore Related Videos
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