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Abstract Details

Atypical Presentation of Reversible Cerebral Vasoconstriction Syndrome at Very Early Pregnancy
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
266

We report a rare case of reversible cerebral vasoconstriction syndrome (RCVS) with vertebral artery dissection and extra-cranial vasospasm occurring during very early pregnancy.

 
RCVS is well recognized clinical-radiological entity characterized by thunderclap headache with diffuse segmental constriction. Commonly seen in late pregnancy or postpartum period. RCVS in early period of organogenesis is rare.
A healthy 36-year-old right-handed African-American female presented with acute onset of nausea, vertigo, right-sided weakness. Head and neck CT angiogram (HN-CTA) demonstrated a left vertebral V4 segment dissection with stenosis. On exam, she had difficulty swallowing, hoarseness, right-eye ptosis, right-gaze nystagmus, dysmetria and 4/5 right-sided weakness. MRI showed left Posterior-inferior-Cerebellar Artery stroke. Over the next few days, she improved and was ambulatory. However, she continued to have headaches and nausea. On hospital day 17th she had acute mental status change with increased right sided weakness. Repeat HN-CTA showed extra-cranial large artery diffuse vasospasm. Non-contrast head showed no intracranial hemorrhage. Diagnostic cerebral angiography showed diffuse vasospasm of bilateral cervical and petrous segment of internal carotid arteries and V2 segment of bilateral vertebral arteries. Repeat MRI was unchanged. Patient improved significantly after 5 day treatment of calcium channel blocker. She was discharged to an acute rehab with dysarthria, dysmetria and mild right-sided paresis.
Two-month repeat neurological exam was normal and MR angiography showed near resolution of arterial vasospasm. In the rehab, she was found to be pregnant. Obstetric examination indicated that she was 5 weeks pregnant at the time of vasospasm. An association between RCVS and arterial dissection has emerged in recent years but the presentation in early pregnancy is extremely rare.
Although, RCVS diagnosed in late pregnancy is well established, early trimester neural change with headache should raise concern for RCVS. This case also raises awareness about getting pregnancy tests in all childbearing women in all acute strokes.
Authors/Disclosures
Shivani Naik, MD (Cedar Sinai Medical Center)
PRESENTER 		Dr. Naik has nothing to disclose.
Gopika Govindan Kutty, MD (UPMC Altoona- Blair Medical Associates) Dr. Govindan Kutty has nothing to disclose.
Naga Krishnakanth Madireddy, MD (Baptist Health Louisville) Dr. Madireddy has nothing to disclose.
Sahil Naik, MD (Einstein Medical Center) Dr. Naik has nothing to disclose.
Kerri S. Remmel, MD, PhD (Regional Brain Institute) Dr. Remmel has nothing to disclose.
Wei Liu, MD Dr. Liu has nothing to disclose.