Reversible cerebral vasoconstriction syndrome with multivessel cervical artery dissections and a double aortic arch

J Stroke Cerebrovasc Dis. 2014 Feb;23(2):e141-3. doi: 10.1016/j.jstrokecerebrovasdis.2013.08.013. Epub 2013 Oct 6.

Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) has been associated with exposure to vasoactive substances and few reports with cervical arterial dissections (CADs). We evaluated a 32-year-old woman with history of depression, migraines without aura, and cannabis use who presented with a thunderclap headache unresponsive to triptans. She was found to have bilateral occipital infarcts, bilateral extracranial vertebral artery dissections, bilateral internal carotid artery dissecting aneurysms, and extensive distal multifocal segmental narrowing of the anterior and posterior intracranial circulation with a "sausage on a string-like appearance" suggestive of RCVS. Subsequently, she was found to have a distal thrombus of the basilar artery, was anticoagulated, and discharged home with no residual deficits. We highlight the potential association of CADs and RCVS. The association of RCVS and a double aortic arch has not been previously reported.

Keywords: Reversible cerebral vasoconstriction syndrome; cannabis; cervical artery dissections; double aortic arch; triptans.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aneurysm, Dissecting / complications*
  • Aneurysm, Dissecting / diagnosis
  • Anticoagulants / therapeutic use
  • Aorta, Thoracic / abnormalities*
  • Cerebral Angiography / methods
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / physiopathology*
  • Cervical Vertebrae / blood supply*
  • Female
  • Headache Disorders, Primary / etiology
  • Humans
  • Magnetic Resonance Angiography
  • Risk Factors
  • Syndrome
  • Thrombosis / complications
  • Thrombosis / drug therapy
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vascular Malformations / complications*
  • Vascular Malformations / diagnosis
  • Vasoconstriction*
  • Vasospasm, Intracranial / complications*
  • Vasospasm, Intracranial / diagnosis
  • Vasospasm, Intracranial / physiopathology
  • Vertebral Artery Dissection / complications
  • Vertebrobasilar Insufficiency / complications
  • Vertebrobasilar Insufficiency / drug therapy

Substances

  • Anticoagulants