A case report of reversible cerebral vasoconstriction syndrome with thunderclap headache significantly exacerbated in the supine position and alleviated in the standing position

Table 1 Cases of reversible cerebral vasoconstriction syndrome with headache exacerbated in the supine position

Authors and year	Lemmens et al. (2012) [11]	Lee et al. (2013) [12]	Gotoh et al. (2019) [13]	This case
Patient	30 y.o. female	17 y.o. female	34 y.o. female	33 y.o. female
Past history	systemic lupus erythematosus, migraine	headache	migraine, anxiety disorder	uterine fibroids
Onset	6th postpartum day	after the seizure	4th postpartum day	5th postpartum day
Headache	thunderclap with nausea, photophobia	thunderclap (Hammer-striking)	thunderclap (body movement exacerbates)	thunderclap with nausea, chills
Blood pressure	129/87 mmHg	154/95 mmHg	113/56 mmHg	158/82 mmHg
CSF pressure	Normal pressure	40 cmH₂O	Not examined	Not examined
Imaging findings	diffuse hyperintensity in cortex and subcortex on FLAIR multiple stenoses in bilateral MCA and PCA	diffusion restriction in bilateral occipital and frontal lobe multiple stenoses in basilar artery	hyperintense vessel sign on FLAIR multiple stenoses in bilateral MCA and PCA	multiple stenoses in bilateral MCA and PCA and basilar artery
Complication	PRES	cerebral infarction, Takayasu’s arteritis, convulsive seizure	None	None
Treatment	magnesium sulfate, antihypertensive treatment	IVMP 1000 mg 3 times, nimodipine 240 mg/day, oral methylprednisolone	verapamil 120 mg/day, concentrated glycerin	verapamil 120 mg/day
Outcome	symptoms and vascular stenoses improved in 2 months	symptoms and cerebral vascular stenoses improved in 1 month	symptoms improved in 10 days, vascular stenoses improved in 2 months	symptoms and vascular stenoses improved on day 43

CSF, cerebrospinal fluid; FLAIR, Fluid-attenuated inversion recovery; PRES, posterior reversible encephalopathy syndrome; MCA, middle cerebral artery; PCA, posterior cerebral artery; IVMP, intravenous methylprednisolone

ISSN: 1471-2377