Reversible Cerebral Vasoconstriction Syndrome with Increased Intracranial Pressure, Probably Related to Altitude Changes and Windy Winter Travelling
Chaitawat Tienviboon MD*, Sompone Punyagupta MD**, Anon Pongtarakulpanit MD***, Surawut Prichanond MD***
Affiliation : * Section of Neurology, Department of Medicine, Vichaiyut Hospital, Bangkok, Thailand ** Section of Infectious Disease, Department of Medicine, Vichaiyut Hospital, Bangkok, Thailand *** Section of Rheumatology, Department of Medicine, Vichaiyut Hospital, Bangkok, Thailand
Reversible cerebral vasoconstriction syndrome (RCVS) has reversible multifocal narrowing of the cerebral arteries. Respiratory alkalosis in high altitude studies cause impairment of the central nervous system, presumably by cerebral vasoconstriction. A 54 year-old woman presented with a 1-week of throbbing headache around her forehead while travelling in moderately high altitude, during a windy winter. Sudden severe headache had progressed and developed bilateral lower visual fields defect along with mild weakness of her right leg on the next day. Magnetic resonance (MR) imaging revealed acute ischemic process at both occipital, parasagittal left parietal and right frontal area. MR venography was negative but MR angiography showed multifocal narrowing of both anterior and posterior circulations. Lumbar puncture revealed the opening pressure of 240 mmH2O but normal CSF profiles. Blood tests, including complete blood count, protein C, protein S, antithrombin III, high-sensitivity C-reactive protein, immunologic and antibody profiles were normal. Dexamethasone and low-molecular weight heparin were given because the intracranial vasculitis and cerebral venous thrombosis could not be ruled out. Visual fields and right leg problems had fully recovered on the second day and second week respectively. Prednisolone was discontinued at the fourth week. MR imaging and MR angiography were repeated in the sixteenth week and revealed old infarction at the left posterior parietal area but narrowing segment of arterial systems were no longer seen. There were a few previous reported cases of RCVS in Asian counties. The authors proposed that altitude changes from travelling to the moderately high altitude and cold windy winter weather were the predisposing factors for the attack of RCVS.
Keywords : Reversible cerebral vasoconstriction syndrome, Altitude, Cold, Increased intracranial pressure, Asian
