Reversible Cerebral Vasoconstriction Syndrome Associated with Vasospasm of the Colic Arteries and Possibly Coronary Vasospasm

Abstract

Male, 48-year-old Reversible systemic vasoconstriction syndrome Chest pain • epigastric pain • headache — Cardiology • General and Internal Medicine • Physiology Rare disease Reversible cerebral vasoconstriction syndrome (RCVS) is a disorder characterized by recurrent thunderclap headaches and reversible cerebral vasoconstriction. Herein, we present the case of a man in his forties with a disease entity related to RCVS accompanied by va-sospasm of the extracerebral blood vessels throughout the body. The patient presented to the Emergency Department with a severe headache and epigastric pain. Initially receiving a misdiagnosis of functional pain, he continued to experience severe recurrent headaches, most often after urinating or defecating and was re-ferred to our department. Suspecting RCVS, we performed magnetic resonance angiography, which revealed beaded irregularity in the right anterior cerebral and V4 vertebral arteries. The patient also had epigastric pain that coincided with each headache. Electrocardiography revealed pronounced ST-segment elevation in leads I and aVL and inverted T wave in lead III, while abdominal computed tomography angiography showed narrow-ing of the colic arteries. We named this disease “reversible systemic vasoconstriction syndrome” (RSVS) as a potential suggested terminology for the future. RSVS is a clinical syndrome characterized by thunderclap headaches and simultaneous unbearable pain in ex-tracerebral organs. To the best of our knowledge, this is the first case report of RCVS with coronary and colic artery vasospasm. We need to take great care of patients with chest or abdominal pain accompanied by recurrent thunderclap headaches, since they can be misdiagnosed with functional or psychogenic disorders.