Reversible Cerebral Vasoconstriction Syndrome Induced by Sumatriptan: A Case Report and Review of Literature

Reversible Cerebral Vasoconstriction Syndrome (RCVS) is characterized by multiple transient cerebral vasoconstrictions that typically resolve within three months, often presenting with sudden thunderclap headaches. Although the cause can be identified in 25 %-60 % of cases, RCVS can also occur spontaneously. Common triggers include vasoactive substances and postpartum states, with the latter accounting for 50 %-60 % of cases. This report discusses a case of RCVS following sumatriptan use.

A 58-year-old woman with controlled hypertension and obstructive sleep apnea presented with recurrent unilateral pulsating headaches, nausea, and photophobia. Initially diagnosed as migraine, she later developed right homonymous hemianopia. Imaging revealed bilateral occipital and parietal strokes with intracranial vasoconstriction. Cerebral angiography confirmed vasospasm, responsive to intra-arterial milrinone. Diagnosed with reversible cerebral vasoconstriction syndrome, she was treated with nimodipine, resulting in complete symptom resolution.

RCVS is a rare syndrome with varied triggers and clinical features, requiring careful evaluation and management. Early diagnosis and vasospasm-targeted therapies, such as nimodipine, are essential for preventing complications. This case underscores the importance of considering RCVS in patients with sudden severe headaches and neurological deficits, particularly those using serotonergic medications.