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Antihistaminik kullanımı ile tetiklenen tekrarlayıcı baş ağrısı ve reversible serebral vazokonstriksiyon sendromu

Reversibl serebral vazokonstriksiyon sendromu (RSVS), Call-Fleming sendromu olarak da bilinen, genellikle 20-40 yaşlarında ve kadınlarda görülen, nörolojik defisitlere neden olabilen gök gürültüsü baş ağrısının nadir nedenlerinden biridir. RSVS nedeni muhtemelen serebral vasküler tonustaki geçici disregülasyonun neden olduğu multifokal arteriyal konstriksiyon ve dilatasyondur. Altmış üç yaşında kadın hasta başının sol tarafında belirgin, ani gelişen, tekrarlayıcı baş ağrısı şikayeti ile başvurdu. Fizik ve nörolojik muayenesi normaldi. Kraniyal manyetik rezonans görüntüleme (MRG) anjiyo incelemelerinde MCA ve PCA'da belirgin olmak üzere damarların distallerinde belirgin vazokonstriksiyon saptandı. Ayırıcı tanıda ilk olarak düşünülen primer SSS anjitisi kranial MRG'de parankim lezyonu ve beyin omurilik sıvısında (BOS) protein artışı olmaması nedeniyle dışlandı. Deksametazon sodyum fosfat 4 mg/ml (4 mg/gün) ve nimodipin 90 mg/gün tedavisi başlandı. Nimodipin dozu kademeli olarak 120 mg/gün'e çıkarıldı. Ek olarak, antihistaminik ajanların kesilmesi ile baş ağrısı belirgin olarak geriledi. RSVS sendromunun vurgulanması gereken en önemli özelliğinin benzer klinik prezentasyon gösteren subaraknoid kanama veya primer santral sinir sistemi (SSS) anjitisinden farklı olarak klinik bulgularının reversibl olmasıdır. Klinik bulgular çoğunlukla düzelmekle birlikte, kalıcı nörolojik defisitler de olabileceği göz önünde bulundurulmalıdır

Reversible cerebral vasoconstriction syndrome and recurrent headache triggered by antihistamine use

Reversible cerebral vasoconstriction syndrome (RCVS), also known as Call-Fleming syndrome, is one of the rare causes of thunderclap headaches, which are most often seen in females aged 20-40 years and which can cause neurological deficits. The cause of RCVS is thought to be multifocal arterial constriction and dilatation caused by transient disregulation of cerebral vascular tonus. Presently described is case of 63-year-old female patient who presented with complaint of sudden onset of recurrent headaches located on the left side. Physical and neurological examinations were normal. Cranial magnetic resonance imaging (MRI) angiography examination showed vasoconstrictions in the distal, particularly in middle cerebral arteries and posterior cerebral arteries. Primary angitis of central nervous system (CNS), first considered in differential diagnosis, was excluded because no parenchymal lesion was seen in cranial MRI and no protein increase was observed in cerebrospinal fluid. Dexamethasone sodium phosphate 4 mg/mL (4 mg/day) and nimodipine 90 mg/day treatment was initiated. Nimodipine dose was gradually increased to 120 mg/day. Headache resolved significantly after discontinuation of antihistaminic agents. The most important feature of RCVS to be highlighted is that clinical signs are reversible, unlike subarachnoid hemorrhage or primary angitis of CNS, which have similar clinical presentations. Although clinical signs of RCVS usually resolve, it should be considered that permanent neurological deficits may occur

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