Baylor University Medical Center Proceedings April 2017 - 218

Right hemispheric reversible cerebral vasoconstriction
syndrome in a patient with left hemispheric partial seizures
Gina S. Perez, MD, Justin McCaslin, MD, and Sadat Shamim, MD

We report a right-handed 19-year-old
girl who developed reversible cerebral
vasoconstriction syndrome (RCVS) lateralized to the right hemisphere with simultaneous new-onset left hemispheric
seizures. RCVS, typically more diffuse,
was lateralized to one of the cerebral
hemispheres.

eversible cerebral vasoconstriction syndrome (RCVS)
is a self-limited, underrecognized clinicoradiologic
syndrome characterized by recurrent thunderclap headaches and
reversible, bilateral, and multifocal
vasoconstriction of cerebral arteries. Calabrese et al proposed the
name of this syndrome in 2007. Figure 1. (a) Axial fluid-attenuated inversion recovery (FLAIR)-weighted magnetic resonance imaging reveals right
We report a patient who had lat- hemispheric sulcal crowding as compared with the contralateral side favored to reflect cerebral edema. (b) Scattered
eralized RCVS possibly due to the foci of right hemispheric cortical diffusion restriction on this diffusion-weighted image indicating multifocal small
vasodilatory eﬀects of seizures that infarctions was confirmed with apparent diffusion coefficient (not shown).
were occurring on the contralateral side.
cortical edema (Figure 1). Magnetic resonance angiography
and subsequent computed tomography angiography revealed
CASE DESCRIPTION
severe right supraclinoid internal carotid artery narrowing and
A right-handed 19-year-old girl with severe developmental
mild right M1-middle cerebral artery narrowing (Figure 2). No
disability, who could converse, make lunch, and ambulate, prestenosis was present within the left intracranial arterial vasculasented with nausea, vomiting, confusion, word-ﬁnding diﬃculture. Transcranial Doppler showed elevated velocities only in the
ty, and fever (100.5°F); when found by her mother, she was in
right middle cerebral artery territory. An electroencephalogram
the fetal position in pain. She had not had signiﬁcant headaches
showed right brain slowing and left brain interictal and ictal
in the past. The patient then developed left-sided hemiplegia
rhythmic sharps with partial seizures (Figure 3).
over the course of 7 days. This was followed by recurrent right
Cerebrospinal ﬂuid (CSF) collected prior to antibiotic iniarm extension with some facial twitching, later conﬁrmed to be
tiation was negative for infections: the red blood cell count
frequent seizures by prolonged electroencephalogram. Her last
was 43 K/μL; white blood cell count, 9 K/μL; protein count,
known seizures occurred at 6 months of age and were attributed
to vaccinations. Her blood pressure was not elevated, with an
From the Department of Radiology (McCaslin) and the Division of Neurology,
initial blood pressure of 102/68 mm Hg.
Department of Internal Medicine (Shamim), Baylor University Medical Center
Magnetic resonance imaging of the brain revealed scattered
at Dallas.
foci of diﬀusion restriction throughout the right hemisphere
Corresponding author: Sadat Shamim, MD, 3600 Gaston Avenue, Wadley Tower
indicating multifocal small infarctions and right hemispheric
Suite 1155, Dallas, TX 75246 (e-mail: sadat.shamim@bswhealth.org).
218

Proc (Bayl Univ Med Cent) 2017;30(2):218-220

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings April 2017