Abstract Details

Title A Pediatric Case of Reversible Cerebral Vasoconstriction Syndrome: Complexity of Diagnosis Amidst Co-Morbid Anxiety and Depression

Topic Child Neurology/Developmental Neurobiology

Presentation(s) P02 - (-)

Poster/Presentation
Number 099

Objective

Background BACKGROUND: Reversible cerebral vasoconstriction syndrome (RCVS) is an important treatable cause of severe headache. It is characterized by segmental constriction of multifocal areas of the cerebral vasculature that is reversible and may be accompanied by neurologic deficits. This condition is commonly described in adults, with a female predominance. Recently, several case studies have been published describing RCVS in children, but all but one have been in boys.

Design/Methods DESIGN/METHODS: We report a case of a 16 year-old overweight female with a history of anxiety, ADHD, and migraines on several psychoactive medications who presented with 2 weeks of constant, progressively worsening headaches that were treated with eletriptan. Complete workup, including head CT, was unremarkable. She then experienced a far more severe headache that woke her from sleep and was associated with vomiting. She was referred for outpatient MRI, which revealed abnormal subarachnoid signal on FLAIR imaging. She was immediately admitted for further workup, and cerebral angiography revealed diffuse cerebral vasoconstriction.

Results RESULTS: All home medications were discontinued, and she was treated with nifedipine. Her symptoms rapidly improved, and repeat angiography at 2 months showed complete resolution of vasoconstriction.

Conclusions CONCLUSIONS: RCVS has only rarely been reported in children and only once in a girl. Our case highlights the importance of considering RCVS when a child presents with severe sudden headache, even in the setting of chronic headaches. With the increased use in children of medications such as triptans and SSRIs, which are risk factors for RCVS, the incidence of RCVS in this population may also rise.

Authors/Disclosures
Devorah Segal, MD, PhD (NYU Langone) PRESENTER	Dr. Segal has nothing to disclose.
Jennifer Bain, MD, PhD (Columbia Doctors)	Dr. Bain has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Consulting. Dr. Bain has received personal compensation in the range of $0-$499 for serving as a Consultant for M3 Consulting. Dr. Bain has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Legal Company . Dr. Bain has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Grin Therapeutics. The institution of Dr. Bain has received research support from Yellow Brick Road Project.
	No disclosure on file
	No disclosure on file
Stephen Thompson, MD (University of Maryland School of Medicine)	No disclosure on file
Achim Berthele, MD	No disclosure on file

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