Reversible Cerebral Vasoconstriction Syndrome Associated With Vortioxetine: A Case Report

Reversible cerebrovascular syndrome (RCVS) is a condition that is clinically characterized by sudden and severe headaches, and its imaging hallmark consists of multifocal phenomena of reversible cerebral vasoconstriction. Multiple triggers are associated with its occurrence, including many types of medication.  A 55-year-old woman with a history of recurrent depressive disorder treated with vortioxetine presented with a sudden-onset thunderclap headache triggered by physical exertion. Neurological examination was unremarkable. CT angiography demonstrated multifocal segmental irregularities involving the bilateral middle cerebral artery branches and pericallosal vessels, consistent with RCVS. No alternative precipitating factors were identified. Vortioxetine was discontinued and replaced with trazodone following Liaison Psychiatry consultation. The patient experienced complete clinical recovery with supportive treatment and was discharged without neurological deficits. This case highlights vortioxetine as a possible precipitating factor for RCVS and supports the growing evidence implicating serotonergic antidepressants in the syndrome. Clinicians should consider RCVS in patients presenting with a thunderclap headache, even after a single episode and in the absence of focal neurological deficits. Prompt recognition, vascular imaging, and withdrawal of the suspected precipitating agent are essential to minimize the risk of neurological complications. Further case reports and pharmacovigilance studies are needed to better define the relationship between vortioxetine and RCVS.