Abstract Details

Title Subarachnoid Hemorrhage Secondary to An Exceedingly Rare Case of STELARA® (Ustekinumab) Induced Reversible Cerebral Vasoconstrictive Syndrome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-008

Objective N/A

Background Stelara® (Ustekinumab) is a human monoclonal antibody that specifically binds to the P40 protein subunit of interleukin-12 and interleukin-23, suppressing the immune response. It is a FDA approved medication, prescribed to patients with Crohn’s disease, ulcerative colitis and psoriasis. Reversible cerebral vasoconstriction syndrome (RCVS) is precipitated by several known triggers, including a single case report of Ustekinumab induced RCVS published in Germany. To our knowledge, this is the first case reported of Ustekinumab induced RCVS in the United States.

Design/Methods 51-year-old female with a medical history of Crohn’s disease and chronic sinusitis presented to the ED with an intractable severe headache. She described an abrupt onset holocephalic headache, reaching 10/10 in intensity within few minutes. Reported a similar episode approximately 2 weeks prior. No neurological deficits on exam. CT head revealed bi-hemispheric multifocal convexity small subarachnoid hemorrhages (SAH). CTA head demonstrated extensive multifocal high-grade narrowing of intracranial vessels with a beading appearance. MRI brain with and without contrast re-demonstrated SAH, without infarcts or abnormal enhancement. Serum ESR and CRP were within normal limits. CSF profile WCB 1, RBC 19, protein 35, glucose 82. She had a negative urine toxicology screen and denied taking over the counter medications or supplements. She was recently on started on subcutaneous Ustekinumab 90mg every 8 weeks for Crohn Disease. She was diagnosed with probable RCVS secondary to Ustekinumab and discharged on Verapamil, discontinued future Usteskinumab injections. Repeat CTA head at 1-month revealed resolution of subarachnoid hemorrhage and significant interval improvement in multifocal beaded appearance of the intracranial arteries, confirming the diagnosis of RCVS.

Results N/A

Conclusions Early and accurate identification of the precipitating etiology for RCVS can lead to a self-liming monophasic disease course with low mortality. To prevent further sequalae of complications, it is imperative to be aware of and avoid all possible RCVS triggers.

Authors/Disclosures
Michael Hadler, DO PRESENTER	Dr. Hadler has nothing to disclose.
Victoria Rice, DO (UC Health Anschutz)	Dr. Rice has nothing to disclose.
	No disclosure on file
Tamra I. Ranasinghe, MD	Dr. Ranasinghe has nothing to disclose.

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