Delayed Positivization of Cerebral Angiography in Reversible Cerebral Vasoconstriction Syndrome (RCVS) Presenting with Recurrent Subarachnoid Haemorrhage



Luca Quartuccio*, 1, §, Francesco Tuniz2, §, Benedetto Petralia3, Bruno Zanotti2, Miran Skrap2, Salvatore De Vita1
1 Clinic of Rheumatology, Azienda Ospedaliero-Universitaria di Udine, DSMB, Italy
2 Department of Neurosurgery, Azienda Ospedaliero-Universitaria di Udine, Italy
3 Department of Neuroradiology, Azienda Ospedaliero-Universitaria di Udine, Italy


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© Quartuccio et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Clinic of Rheumatology, DSMB, University of Udine, Univerisyt Hospital “Santa Maria della Misericordia”, Udine, Piazzale Santa Maria della Misericordia, 15, Italy; Tel: 0039 0432 559352; Fax: 0039 0432 559472; E-mail: quartuccio.luca@aoud.sanita.fvg.it
§ L. Quartuccio and F. Tuniz equally collaborated to this work.


Abstract

Benign angiopathy of the central nervous system is a clinical syndrome with evidence of reversible cerebral vasoconstriction (RCVS). Haemorrhagic stroke, either subarachnoid or intracerebral is an unusual presentation of RCVS. We describe a case of RCVS presenting with a subarachnoid haemorrhage (SAH), with rebleeding and onset of hydrocephalus during the first week, and, notably, delayed evidence of typical angiographic features after two negative prior exams. Normalization of the angiographic vasculitic-like lesions was documented at month +6. Repeated cerebral angiograms are mandatory to exclude this kind of disease, and the uncommon presentation of this case reinforces this concept.

Keywords: Reversible cerebral vasoconstriction syndrome, angiography, hydrocephalus, subarachnoid haemorrhage, vasculitis..