Reversible cerebral vasoconstriction syndrome associated with hyperosmolar hyperglycaemic state: A case report and literature review |
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| Institution: | 1. Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3000, Australia;2. National Trauma Research Institute, 85-89 Commercial Road, Melbourne, VIC 3004, Australia;3. Department of Surgery, University of Melbourne, Parkville, VIC 3010, Australia;1. Alanya Alaaddin Keykubat University, Department of Neurology, Antalya/Alanya, Turkey;2. Alanya Alaaddin Keykubat University, Department of Psychiatry, Antalya/Alanya, Turkey;3. Istanbul Medipol University, Restorative and Regenerative Medicine Center, Istanbul, Turkey;4. Alanya Alaaddin Keykubat University, Department of Radiology, Antalya/Alanya, Turkey;5. Istanbul Medipol University, Department of Neurology, Istanbul, Turkey;6. Istanbul Sancaktepe Research Hospital, Department of Rhinology, Istanbul, Turkey;1. Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA;2. Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA;3. Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA;1. Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia;2. Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA;1. Medical-Surgical Research Center, University of Cartagena, Cartagena, Colombia;2. Neurosurgeon-Critical Care, Biomedical Research Center, University of Cartagena, Cartagena de Indias, Colombia;3. Department of Neurosurgery, All India Institute of Medical Sciences, India |
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| Abstract: | Reversible cerebral vasoconstriction syndrome (RCVS) is an uncommon disorder characterised by thunderclap headache and self-resolving angiographic vasospasm in the presence or absence of neurological deficit. We present the first case of RCVS likely precipitated by a complex array of confounding factors including a hyperosmolar hyperglycaemic state (HHS), induction chemotherapy with cyclophosphamide, non-Hodgkin’s lymphoma, pancytopenia and previous blood transfusions. However, the clinical presentation in this case of altered conscious state followed by thunderclap headache was highly suggestive of HHS being the crucial inciting factor. This report of RCVS associated with HHS lends unique insight into key underlying pathophysiological mechanisms, and warns of the need to maintain a high index of suspicion for this elusive condition given the dynamic and transient nature of its clinical and radiological features. |
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| Keywords: | Reversible cerebral vasoconstriction syndrome Hyperosmolar hyperglycaemic state Cyclophosphamide Thunderclap headache |
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