Diffuse cerebrovascular dilation: Case report of amezinium metilsulfate-induced reversible cerebral vasoconstriction syndrome.

Abstract

BACKGROUND:

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches with reversible cerebral vasoconstriction, and often precipitated by the postpartum state and vasoactive medications. We describe a case of a patient with RCVS induced by amezinium metilsulfate, a sympathomimetic drug, in whom magnetic resonance angiography (MRA) initially revealed diffusely dilated cerebral arteries.

CASE DESCRIPTION:

A 34-year-old woman was prescribed amezinium metilsulfate for hypotension. Twelve days later, she suffered from abrupt severe headaches and was referred to our department. She had no neurological deficits; however, MRA revealed diffusely dilated anterior, middle, and posterior cerebral arteries with vasoconstriction. She was tentatively diagnosed with RCVS and successfully treated with verapamil for headache. Nevertheless, follow-up MRAs disclosed widespread segmental vasoconstriction that resolved in two months.

DISCUSSION:

Diffuse cerebrovascular dilation has not been addressed but may be associated with RCVS pathophysiology. In addition, physicians should bear in mind that amezinium metilsulfate can potentially induce RCVS.

• Authors: Makoto Kobayashi
• Journal: Cephalalgia : an international journal of headache (Cephalalgia) Vol. 36 Issue 3 Pg. 289-93 (Mar 2016) ISSN: 1468-2982 [Electronic] England
• PMID: 26016487 (Publication Type: Case Reports, Journal Article)
• Copyright: © International Headache Society 2015.

Chemical References

• Pyridazines
• Sympathomimetics
• amezinium

Topics

• Adult
• Brain (blood supply)
• Female
• Headache Disorders, Primary (chemically induced)
• Humans
• Hypotension (drug therapy)
• Magnetic Resonance Angiography
• Pyridazines (adverse effects)
• Sympathomimetics (adverse effects)
• Vasoconstriction (physiology)
• Vasodilation (physiology)
• Vasospasm, Intracranial (chemically induced)