Advanced

Segmental cerebral vasoconstriction: successful treatment of secondary cerebral ischaemia with intravenous prostacyclin.

Grände, Per-Olof LU ; Lundgren, Anders; Bjartmarz, Hjalmar LU and Cronqvist, Mats LU (2010) In Cephalalgia 30(7). p.890-895
Abstract
We describe a 23-year-old male patient who presented with spontaneous intermittent and increasing attacks of severe, left-sided thunderclap headache combined with rapidly progressive muscle weakness and dysphasia, including gradual loss of consciousness. Subsequent CT, MRI and DSA showed progressive brain ischaemia and oedema within the left cerebral hemisphere with strict ipsilateral segmental arterial vasoconstriction. Despite extensive medical care, including steroids, the patient deteriorated rapidly. However, the clinical course changed dramatically within 15 h after the start of an intravenous infusion of prostacyclin at a dose of 0.9 ng/kg/min, with an almost complete recovery of consciousness and speech. In addition the... (More)
We describe a 23-year-old male patient who presented with spontaneous intermittent and increasing attacks of severe, left-sided thunderclap headache combined with rapidly progressive muscle weakness and dysphasia, including gradual loss of consciousness. Subsequent CT, MRI and DSA showed progressive brain ischaemia and oedema within the left cerebral hemisphere with strict ipsilateral segmental arterial vasoconstriction. Despite extensive medical care, including steroids, the patient deteriorated rapidly. However, the clinical course changed dramatically within 15 h after the start of an intravenous infusion of prostacyclin at a dose of 0.9 ng/kg/min, with an almost complete recovery of consciousness and speech. In addition the pathophysiological alterations seen on magnetic resonance (imaging and digital) subtraction angiography including diffusion-weighted imaging and apparent diffusion coefficient maps shortly before prostacyclin treatment were clearly reduced when the patient was examined 3-4 days later and he continued to recover thereafter. Although not fully compatible, our case had several clinical characteristics and radiological findings reminiscent of those of the 'segmental reversible vasoconstriction syndrome', sometimes called the Call-Fleming syndrome. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Cephalalgia
volume
30
issue
7
pages
890 - 895
publisher
Wiley-Blackwell
external identifiers
  • WOS:000279533400018
  • PMID:20647181
  • Scopus:78349291909
ISSN
0333-1024
DOI
10.1177/0333102409352909
language
English
LU publication?
yes
id
5b2eaabe-d222-4491-ac2f-c46479647516 (old id 1644702)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20647181?dopt=Abstract
date added to LUP
2010-08-05 10:13:21
date last changed
2016-10-13 04:27:00
@misc{5b2eaabe-d222-4491-ac2f-c46479647516,
  abstract     = {We describe a 23-year-old male patient who presented with spontaneous intermittent and increasing attacks of severe, left-sided thunderclap headache combined with rapidly progressive muscle weakness and dysphasia, including gradual loss of consciousness. Subsequent CT, MRI and DSA showed progressive brain ischaemia and oedema within the left cerebral hemisphere with strict ipsilateral segmental arterial vasoconstriction. Despite extensive medical care, including steroids, the patient deteriorated rapidly. However, the clinical course changed dramatically within 15 h after the start of an intravenous infusion of prostacyclin at a dose of 0.9 ng/kg/min, with an almost complete recovery of consciousness and speech. In addition the pathophysiological alterations seen on magnetic resonance (imaging and digital) subtraction angiography including diffusion-weighted imaging and apparent diffusion coefficient maps shortly before prostacyclin treatment were clearly reduced when the patient was examined 3-4 days later and he continued to recover thereafter. Although not fully compatible, our case had several clinical characteristics and radiological findings reminiscent of those of the 'segmental reversible vasoconstriction syndrome', sometimes called the Call-Fleming syndrome.},
  author       = {Grände, Per-Olof and Lundgren, Anders and Bjartmarz, Hjalmar and Cronqvist, Mats},
  issn         = {0333-1024},
  language     = {eng},
  number       = {7},
  pages        = {890--895},
  publisher    = {ARRAY(0xa25f600)},
  series       = {Cephalalgia},
  title        = {Segmental cerebral vasoconstriction: successful treatment of secondary cerebral ischaemia with intravenous prostacyclin.},
  url          = {http://dx.doi.org/10.1177/0333102409352909},
  volume       = {30},
  year         = {2010},
}