Possible Reversible Cerebral Vasoconstriction Syndrome Associated with Eucalyptus: Case Report

Abstract

Background—Reversible cerebral vasoconstrictive syndrome (RCVS) has characteristic clinical features,
brain imaging and Angiographic features. The majority of RCVS cases are associated with the use of antidepressants, polysubstance abuse, and nasal decongestants. We here present a case that highlights the use of
eucalyptus herbs as a possible precipitant factor for RCVS formation.
Case Presentation—A 42-year-old woman presented to the emergency department with a tingling sensation on the right-hand side of her body and a two-week progressive throbbing severe holocranial headache radiating to the neck, with associated nausea, photophobia, and phonophobia. She denied any seizures
and recent trauma or fevers. She was not taking scheduled medications, but she had used inhaling vapors
obtained from boiling eucalyptus leaves to alleviate sinus congestion. Initial imaging revealed subarachnoid
hemorrhage at bilateral posterior parietal convexity leading to her admission into the intensive care unit.
Further work up disclosed the presence of findings consistent with RCVS.
Conclusion—In conclusion, we hereby postulate that some herbal remedies used in alternative medicine,
including eucalyptus, could play a role in causing serotonergic symptoms including dizziness, diarrhea, and
cerebral vasoconstriction. Understanding that eucalyptus has the potential to contribute to RCVS due to its
serotoninergic activity may be of importance in the diagnosis and management of these patients.