Reversible Cerebral Vasoconstriction Syndrome evoked by Diving

초록

Reversible cerebral vasoconstriction syndrome (RCVS) is a disorders characterized by severe headmultifocal stenosis in cerebral vessels. RCVS is reversible and patients usually recover within a fewHowever, serious complications like seizure and stroke, can be associated with RCVS if not prompand treated. The cause of RCVS is unclear but this disorder is more commonly diagnosed in womages of 20 to 50, and a history of migraine is nearly always found in patients with RCVS. Other evassociated with RCVS include use of drugs, antidepressant or alcohol, hypercalcemia and head tradescribed the young woman with RCVS during breath holding.The 34-year old woman was admitted for sudden onset thunderclap headache during underwatefor leisure. Headache occured after 30-40 seconds of breath holding. The severe headache lastedmonth and she underwent brain MR scans and was transferred to our hospital. She had the histomigraine and no other vascular risk factors. The outdise brain MR scans evaluated after two days onset indicated the typical feature of RCVS like mutifocal narrowing in multiple vessels including without stroke or SAH. We tried the calcium channel blocker and NSAIDS and then headache disconventional angiography after one month, showed the recovery of the previous stenosis. Transcand echocardiography indicated the pulmonary aertriovenous malformation(AVM) and large Pateovale.Association between RCVS and right to left shunt like PFO and Pulmonary AVM was not known. Tstudy showed that cerebral arterial tone during breath hold test is abnormal in RCVS, which mighthe breath holding could be potential evoking factors for RCVS. RCVS is frequently missed or mismigraine. If sudden severe headache occurs after breath holding, RCVS also should be considered