LAUSR

A 64-year-old woman presented to the Emergency Department (ED) after she experienced a sudden onset of ‘worst headache of her life’, which reached peak intensity several seconds later. She had some nausea, but no vomiting or loss of consciousness. She did not report any neurologic deficits, and denied a history of similar headaches in the past. She was taken by ambulance to the ED, where a non-contrast CT scan was obtained. The CT scan showed trace sulcal hyperdensity at the vertex, concerning for subarachnoid hemorrhage. There was no additional hemorrhage, abnormal hypoattenuation, or hydrocephalus on the CT. A CT angiogram was performed, and showed mild-to-moderate multifocal segmental narrowing of anterior and middle cerebral arteries without aneurysmal dilatation. A conventional angiogram was performed, and confirmed diffuse multifocal narrowing and mild dilatation of all the cerebral vessels consistent with a reversible cerebral vasoconstriction syndrome (Fig. 1). The patient was started on oral verapamil twice a day, and did not experience any further headaches. A follow-up angiogram performed 3 months later was normal.