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Amphetamine Induced Reversible Cerebral Vasoconstriction Syndrome (RCVS)
EP30506
Poster Title: Amphetamine Induced Reversible Cerebral Vasoconstriction Syndrome (RCVS)
Submitted on 25 Aug 2019
Author(s): Muhammad Waqas Ilyas & Aamir Ijaz
Affiliations: Hull & East Yorkshire Hospitals NHS Trust
Poster Views: 197
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Poster Information
Abstract: A 38 years old lady was admitted with a thunderclap headache & vomiting but with no neck stiffness. She had a past medical history of type 2 diabetes and denied any recreational substance abuse. CT head and LP were negative for subarachnoid haemorrhage. She was hypertensive with a BP of 159/89 mm Hg on admission. She was given Ramipril and was subsequently discharged. Two days later, she was readmitted with worsening thunderclap headache. MRI head and CT angiogram were performed which suggested aneurysms, a possibility of vasculitis, and vasospasm. Catheter angiogram showed grossly abnormal irregular vasculature, right MCA bifurcation, and anterior communicating aneurysms, suggestive of vasculitis. She had a trial of IV methylprednisolone. Upon re-exploration of the history, she admitted to abusing amphetamines. Comprehensive blood tests including ANA, ANCA ,HIV, syphilis, and lupus serology were performed, which all came back as negative. Her symptoms improved after a week. Repeat CTA after 3 months showed fusiform right vertebral artery aneurysm enlarging over 2 months, stable anterior communicating and right MCA aneurysms, and resolving vasospasm. A final diagnosis of RCVS was therefore made. Her case was referred to the neuroradiology and the vascular teams. The vertebral artery was stented and the right MCA aneurysms were coiled. She was followed up in the clinic after 2 months and remained symptoms free. Repeat CTA demonstrated complete resolution of vasospasm.
Summary: A case study of a patient who presented with symptoms masquerading as a primary CNS pathology. However, was later diagnosed as having reversible cerebral vasoconstriction syndrome secondary to amphetamine use.References: 01) https://www.uptodate.com/contents/reversible-cerebral-vasoconstriction-syndromes
02) https://www.ncbi.nlm.nih.gov/pubmed/2124040
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