Introduction
Reversible cerebral vasoconstriction syndrome (RCVS) is a disorder characterized by thunderclap headaches, often accompanied by neurological abnormalities and reversible constriction of cerebral arteries. In this report, we present a case of a 44-year-old female patient with RCVS.
Case Report
A previously healthy patient reported a weight loss of 4-5 kg over the past month and abdominal pain during meals. She was hospitalized and diagnosed with advanced gastric cancer (AGC) with peritoneal seeding. She underwent emergency ileostomy due to obstruction of T-colon. Postoperatively, the patient exhibited motor aphasia and a confused mentality. Neurological examination revealed a NIHSS score of 8 (LOC questions 2, LOC commands 1, Language 3, Dysarthria 2). MRI showed hyperintense signal intensity (HSI) suggestive of ischemic stroke in mltiple territory. MRA revealed severe stenosis in both ACA and PCA. Follow-up imaging suggested high frontal subarachnoid hemorrhage (SAH) and diffuse intracranial stenosis. Differential diagnoses included vasospasm of unknown etiology, vasculitis, and cerebral venous thrombosis (CVT). A TFCA was performed, confirming multifocal stenosis in the whole cerebral vasculature. Treatment with nimodipine successfully normalized vessel constriction, leading to a diagnosis of RCVS.
Discussion
The initial symptoms were aphasia and a confused mentality, which are not typical presentations of RCVS. The connection between gastrointestinal issues and the development of RCVS, similar to previously reported cases of gastrointestinal bleeding from a GIST, suggests that significant gastrointestinal stress might act as a precipitating factor for RCVS.