Reversible Segmental Cerebral Vasoconstriction (Call-Fleming Syndrome): Are Calcium Channel Inhibitors A Potential Treatment Option?

The Call-Fleming syndrome is characterized by sudden onset of thunderclap-like headache and focal neurological deficits. The pathophysiological correlate is a reversible segmental cerebral vasoconstriction frequently associated with focal cerebral ischaemia. The syndrome has been described in a vari...

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Bibliographic Details
Published in:Cephalalgia 2003-04, Vol.23 (3), p.218-222
Main Authors: Nowak, DA, Rodiek, SO, Henneken, S, Zinner, J, Schreiner, R, Fuchs, H-H, Topka, H
Format: Article
Language:English
Subjects:
Calcium Channel Blockers - therapeutic use
calcium channel inhibitor
Call–Fleming syndrome
Cerebral Angiography - methods
Constriction, Pathologic
Female
Humans
Magnetic Resonance Imaging - methods
Nimodipine - therapeutic use
Reversible segmental cerebral arterial vasoconstriction
stroke
treatment
Vasospasm, Intracranial - diagnosis
Vasospasm, Intracranial - drug therapy
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Summary:The Call-Fleming syndrome is characterized by sudden onset of thunderclap-like headache and focal neurological deficits. The pathophysiological correlate is a reversible segmental cerebral vasoconstriction frequently associated with focal cerebral ischaemia. The syndrome has been described in a variety of clinical conditions, and recently an association between the syndrome and exposure to vasoactive drugs was observed. Effective treatment options are not known. A 63-year-old female developed sudden ‘worst ever’ headache. Initial neurological examination, laboratory blood tests, CSF examination and brain magnetic resonance imaging (MRI) were normal. Previous medical history was unremarkable and she did not take vasoactive drugs. Eleven days after the onset of headache she developed visual field impairment and a right-sided hemiparesis. Brain MRI revealed bilateral posterior and left parietal ischaemic strokes. Cerebral catheter angiography showed segmental arterial vasoconstriction. A vasodilatative therapy with calcium channel inhibitors was started and serial transcranial Doppler ultrasonography demonstrated resolution of cerebral arterial vasoconstriction. The present case illustrates that calcium channel inhibitors may be an effective therapy for segmental cerebral arterial vasoconstriction. However, more clinical data are needed to prove this observation.
ISSN:0333-1024
1468-2982
DOI:10.1046/j.1468-2982.2003.00507.x