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Case Reports in Neurological Medicine
Volume 2014 (2014), Article ID 782028, 7 pages
http://dx.doi.org/10.1155/2014/782028
Case Report

Dramatic Intracerebral Hemorrhagic Presentations of Reversible Cerebral Vasoconstriction Syndrome: Three Cases and a Literature Review

1Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
2Department of Internal Medicine, University of Illinois College of Medicine at Urbana-Champaign, Urbana, IL 61801, USA
3University of Illinois College of Medicine at Urbana-Champaign, Urbana, IL 61801, USA
4Department of Neurosurgery, University of Illinois College of Medicine at Urbana-Champaign, Carle Foundation Hospital, 602 West University Avenue, Urbana, IL 61801, USA

Received 24 September 2013; Accepted 10 October 2013; Published 12 January 2014

Academic Editors: J. C. Kattah and D. J. Rivet

Copyright © 2014 Joel M. Stary et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) refers to a number of disorders characterized by severe and sudden-onset (“thunderclap”) headaches and angiographic features of reversible, segmental, multifocal vasoconstriction of cerebral arteries. Although RCVS generally resolves without significant sequelae, a rare and possibly underrecognized hemorrhagic presentation has a worse potential course. We report three cases of hemorrhagic RCVS and review the literature. Three females (42, 54, and 33 years old, resp.) presented with severe headache, neurological deficits, and dramatic intracerebral hemorrhage (ICH). Patient 1 presented comatose with a 9 × 4 × 6.6 cm left deep intraparenchymal hemorrhage (IPH) and 1 cm midline shift. She underwent emergent surgical intervention. Patient 2 had a 3.3 × 1.5 cm left superior frontal IPH that enlarged to 4 × 2.5 cm within 12 hours with worsening headache and neurological deficits. She was successfully managed nonoperatively. Patient 3, after uncomplicated pregnancy and delivery, presented with a 1.5 cm left superior parietal IPH on postpartum day 7. Two days later, she acutely developed right hemiplegia. Repeat CT demonstrated a new 3.3 × 1.7 cm left frontal IPH. She was also successfully managed nonoperatively. Many diverse conditions are grouped within the category of RCVS. Dramatic ICH remains a rare and possibly underrecognized presenting feature. Prompt diagnosis and management are essential for obtaining the best outcome.