Mystery of Reversible Cerebral Vasoconstriction Syndrome (RCVS): An Interesting Case Report

Abstract

\n BackgroundReversible Cerebral Vasoconstriction Syndrome is a condition of transient cerebral vascular spasms presenting with recurrent thunderclap headaches and recovery within three months. Several probable triggers and underlying factors, such as sex hormones, vasoactive drugs, head trauma or surgery, and tumors, have been implicated.Case presentationIn this paper, we present a 53-year-old woman with severe thunderclap headaches and normal lab tests who was radio-clinically diagnosed with reversible cerebral vasoconstriction syndrome and treated accordingly. Then, she experienced the recurrence of RCVS after about 2 years and headaches after one year in association with high blood pressure, high blood sugar, hypothyroidism, hyperlipidemia, and a urine metanephrine level of 5 times higher than the normal limit, suggesting a diagnosis of pheochromocytoma. After confirmation of the diagnosis with further imaging studies, surgical removal of the tumor resolved all the signs and symptoms. ConclusionOften underdiagnosed, pheochromocytoma could be an important condition associated with RCVS. It is important for clinicians to bear this diagnosis in mind while dealing with similar cases of recurrent thunderclap headaches.