Reversible cerebral vasoconstriction syndrome and nonaneurysmal subarachnoid hemorrhage

Abstract

Background—Reversible cerebral vasoconstriction syndrome was first described by Call, Fleming, and
colleagues. Clinically this entity presents acutely, with severe waxing and waning headaches (“thunderclap”), and occasional fluctuating neurological signs.
Case presentation—We present four subsequent cases of patients with severe thunderclap headache and
brain tomography with evidence of subarachnoid hemorrhage. The brain angiogram showed no aneurysm
but intracranial vasculopathy consistent with multiple areas of stenosis and dilatation (angiographic beading) in different territories.
Conclusion—Neurologists should be aware of Call Fleming syndrome presenting with severe headache
and associated convexity subarachnoid hemorrhage. After other diagnoses are excluded, patients can be
reassured about favorable prognosis with symptomatic management.