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Reversible cerebral vasoconstriction syndrome presenting as thunderclap headache following high-altitude exposure and
Oscar H Del Brutto1, Eduardo J Guzmán2, Rafael Caputi3
1School of Medicine, Universidad Espiritu Santo - Ecuador, Ecuador; Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
Background:
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of thunderclap headache, often triggered by environmental or pharmacologic stressors.
Methods:
A 56-year-old women presented with thunderclap headache and focal neurological signs following high-altitude exposure and coca leaf tea consumption RESULTS: Neuroimaging demonstrated acute ischemic lesions in different arterial territories and severe narrowing of all medium-diameter intracranial arteries. She was started on dual antiplatelet therapy, intravenous fluids, and was instructed to remain in bed in a strictly flat position. Repeated MRI showed marked improvement of both ischemic lesions and the arterial vasospasm.
Conclusion:
High-altitude hypoxia and sympathomimetic alkaloids may synergistically precipitate RCVS. Awareness of traditional remedies and environmental exposures is essential in evaluating acute neurological syndromes in travelers.
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