We present a 6-year-old male with HbSS and mild persistent asthma was admitted for vaso-occlusive crisis and developed acute neurologic symptoms on hospital day 4, including severe headache, left eye pain, and hypertension (Pediatric NIH Stroke Scale: 3). Magnetic resonance imaging (MRI) stroke study showed a small right frontal subarachnoid hemorrhage (SAH) with adjacent thin subdural collection (SDH) and vessel imaging (CTA brain) showed findings suggestive of possible reversible cerebral vasoconstriction syndrome (RCVS). He was started on nimodipine and repeat imaging 7 days after admission revealed interval development of several small foci of ischemia in the posterior greater than anterior white matter, left parasagittal occipital, and parietal lobes with mild associated cortical swelling. FLAIR imaging showed a possible Ivy sign suggestive of cerebral vasculopathy, however dedicated vessel imaging was unrevealing.

He remained in the intensive care unit for close neuromonitoring for continued intractable headaches, while undergoing serial transcranial dopplers (TCD). He subsequently reported vertical diplopia 11 days after admission, and TCDs showed elevated pulsatile indices suggesting possible increased intracranial pressure. Ophthalmology confirmed bilateral grade III papilledema on their examination. Lumbar puncture obtained showed an opening pressure of > 55 cm H20 consistent with IIH, for which he was started on acetazolamide, with gradual improvement in headache and his papilledema.