Reversible cerebral vasoconstriction syndrome occurring after surgery for uterine cancer with severe anemia: a case report

Abstract

A44－year－old woman with a history of migraine presented with lower abdominal pain in early August 2012． Blood examination revealed severe anemia（hemoglobin 4．7 g／dl）， and she was diagnosed with uterine cancer． After a transfusion and administration of an oral iron preparation， her anemia improved． Quasi－extensive total hysterectomy and bilateral salpingo－oophorectomy were performed in late September． She was admitted fbr a severe headache in late October． Magnetic resonance imaging revealed findings indicative of posterior reversible encephalopathy syn－ drome． Repeated headaches spreading from posterior to anterior occurred after hospitalization． A thunderclap head－ ache occurred the moment she came in contact with hot water while taking a shower on day 6 after admission． She was sedated because she developed generalized convulsion and restlessness． Brain computed tomography（CT） showed left temporal lobe hemorrhage， and reversible cerebral vasoconstriction syndrome（RCVS）was considered． Her headache improved after the administration of 240 mg／day verapamil． Three－dimensional CT angiography re－ vealed broad cerebral vasoconstrictions on day l 2 after admission． This condition resolved on day 69， and she was di－ agnosed with RCVS． In addition to correction of anemia， estrogen deficiency due to surgery for uterine cancer may cause RCVS．