At the most recent annual meeting for the Association of Academic Physiatrists in New Orleans, Mayo Clinic physiatrists and residents presented many posters, including the one above titled, “Reversible Cerebral Vasoconstriction Syndrome Secondary To High Altitude and Vasoactive Medication: A Case Report.”
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare occurrence that often is misdiagnosed as a migraine, and to our knowledge, this was the first documented case of RCVS caused by a combination of acute respiratory alkalosis followed by migraine abortive therapy.
In this case report, a healthy 57-year-old, right-handed woman with history of borderline hypertension and migraines developed a thunderclap headache while skiing in Colorado. An initial MRI was negative, and she was prescribed sumatriptan. Her symptoms progressed over the next two weeks including frank confusion, gait imbalance, and visual hallucinations.
When she came to Mayo Clinic, a herneurological examination revealed oculomotor dysfunction,left-hemineglect, right homonymous hemianopsia, gait ataxia, dysmetria and delayed visual processing. She was labile, but her cognition, speech and language appeared normal. MR imaging and angiography identified bilateral subacute perirolandic and parieto-occipital infarcts as well as mid- and distal arterial narrowing of her anterior, posterior and middle cerebral arteries. Lumbar puncture and leptomeningeal biopsies were unremarkable and she was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS).
Sumatriptan was immediately discontinued and she was maintained on oral verapamil. She was admitted to inpatient rehabilitation for intensive visual-spatial and perceptual training, neuromuscular re-education, and gait training. Three months later, she had had a near-complete functional recovery.
To see the complete poster click here.