Reversible cerebral vasoconstriction syndrome is a group of conditions that presents with narrowing of multiple cerebral arteries, mostly idiopathic but sometimes associated with drugs like antidepressants, for example selective serotonin reuptake inhibitors.

A 23 years old patient ingested 150 mg of Sertraline because she missed her anxiety disorder treatment for 30 days and came six hours later to the emergency department presenting with low level of consciousness, a global aphasia and a right and complete hemiparesis, her NIHSS was 15. Twelve days before, she underwent a surgery for resection of a large fronto-temporo-esphenoidal meningioma that caused a vasoconstriction of the left M1 segment, inferior brunch of M2 segment and cerebral anterior artery which caused no clinical deficits at the time.

She underwent a tomography imaging of the brain because of the stroke clinical suspicion. A cortical-subcortical hypodensity on the parasagittal segment of the left frontal lobe projecting to the ipsilateral cingulate gyrus, superior frontal gyrus and corpus callosum associated with a thinning of the distal segment of the intern carotid artery and the M1 segment medial cerebral artery, worse than the previous vascular study.

Suspecting a vascular pathology, she underwent a digital angiographic study that showed a vasospasm of the affected artery, and, after 14 mg of intraarterial Milrinone with significant reduction of vasospasm of the middle and anterior cerebral artery and complete resolution of clinical symptoms, with NIHSS of 0.

She was admitted to the intensive care unit, were she underwent more diagnostic studies and a complementary therapeutic with intravenous milrinone and  oral verapamil with the clinical suspicion of reversible cerebral vasoconstriction syndrome.

We showed this case to discuss the worsening of a previous vasospasm probably induce by sertraline and the correlation to a reversible cerebral vasoconstriction syndrome spectrum, reverted with Milrinone and Verapamil.