Reversible Cerebral Vasoconstriction Syndrome Secondary to Escitalopram

Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) is a relatively rare and underdiagnosed neurological condition that has similar clinical presentation to other neurological emergencies. Antidepressants such as selective serotonin reuptake inhibitors can be a secondary cause of RCVS. We present the case of a healthy young woman, with long term escitalopram use, who presented with bilateral neurological deficits and was found to have RCVS, whose symptoms improved remarkably after intra-arterial calcium channel blocker treatment. We discuss risk factors, theorized mechanisms, presentation, diagnostic tools, and management of RCVS. Our case should serve as a corollary for physicians to consider RCVS as a differential diagnosis for thunderclap headache, especially in patients with selective serotonin reuptake inhibitor use.