Reversible cerebral vasoconstriction syndrome complicated by bilateral intracerebral haemorrhage
A 55-year-old woman presented to the emergency room with a thunderclap headache and repeated vomiting. She had been previously well, apart from treatment for depression with duloxetine, a serotonin-norepinephrine reuptake inhibitor. She smoked cigarettes. On examination, she was afebrile. Pupils were equal and reactive to light. Her Glasgow Coma Scale (GCS) score was 14 (eyes opening to speech). There was no focal neurological deficit. CT scan of head showed right-sided cortical subarachnoid haemorrhage (figure 1A) while CT cerebral angiography was normal. The headache improved, and she was discharged 2 days later with nortriptyline substituted for duloxetine.
She was readmitted the next day after another episode of thunderclap headache and deterioration in level of consciousness to a GCS of 11 (eyes opening to speech, incomprehensible sounds and obeying commands). Her admission blood pressure was 216/110 mm Hg, for which she received labetalol. A repeat CT scan of the head showed a haemorrhage...
Source: Practical Neurology - Online First Published 20 Oct 2026 Imported 20 Oct 2026 Relevancy: Not reviewed
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