BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is a rare
neurological disorder with a complex physiopathology that is not fully understood. Suggested underlying mechanisms include failure of autoregulation, endothelial dysfunction, and oxidative stress. It is characterized by reversible multifocal constriction of the cerebral arteries, and can be triggered by many conditions, including, vasoactive medications (eg,
triptans), cerebrovascular events,
primary headache disorders, and metabolic causes (eg,
hypercalcemia). RCVS can also be associated with pregnancy-related conditions, such as
thrombotic thrombocytopenic purpura,
eclampsia, and
pre-eclampsia.
Thunderclap headache is the most common clinical manifestation; however, other symptoms can result from complications of the disease, such as
stroke,
brain edema, and
seizures. Several case reports have been published of an association between RCVS and
eclampsia, but to the best of our knowledge, only 3 cases were successfully treated with intravenous
milrinone and this is the only patient reported in Saudi Arabia. CASE REPORT We report a case of 25-year-old primigravida woman who presented with acute-onset
headache,
nausea, elevated blood pressure, and
generalized tonic clonic seizure. She was diagnosed as having RCVS secondary to
eclampsia based on clinical and radiological features. She was initially started on
nimodipine, which is usually the first-line management of RCVS, as well as
magnesium sulfate and
levetiracetam; however, she only achieved full recovery after starting intravenous
milrinone. CONCLUSIONS
Milrinone is one of the emerging drugs for treatment of RCVS, and this case report delineates the potential of using the
drug, especially in cases refractory to standard
therapy.