Reversible Cerebral Vasoconstriction Syndrome: An Important Cause of Post Coital Thunderclap Headache

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracranial haemorrhage which is often unrecognized. There are no specific causes of the syndrome but many clinical conditions and drugs have been observed to be responsible for this syndrome. Often calcium channel blockers (CCBs) are used to relieve the symptoms. Here we will discuss a case of RCVS that was triggered by sexual intercourse. A 42 years old male presented to our hospital with a sudden thunderclap headache following sexual intercourse with vomiting several times. TCD (Transcranial Doppler) ultrasound showed high MFV (Mean flow velocity) in multiple arteries suggestive of moderate to severe stenosis. CT angiogram of the brain revealed multifocal segmental spasm. Then the patient was treated conservatively with analgesics and Nimodipine. The patient made a good recovery following this treatment. Reversible cerebral vasoconstriction syndrome remains an underdiagnosed presentation of thunderclap headache which can be triggered by sexual intercourse. It should be an important consideration in cases where SAH has been ruled out. Threatening outcomes could be averted if the excruciating headache is promptly evaluated and managed accordingly. All other parameters of general physical examination were within the normal limits. Any focal neurological deficit, the detailed neurological examination did not reveal. There was no neck stiffness or any other sign of meningeal irritation. Reversible cerebral vasoconstriction syndrome remains an underdiagnosed presentation of thunderclap headache which can be triggered by sexual intercourse. It should be an important consideration in cases where SAH has been ruled out. Threatening outcomes could be averted if the excruciating headache is promptly evaluated and managed accordingly.