Reversible cerebral vasoconstriction syndrome associated with putaminal hemorrhage.

A 42-year-old woman with history of analgesic overuse and episodic migraine without aura presented thunderclap headache. She then ingested 4.5 g of dipyrone, 0.75 g of isometheptene, 0.45 g of caffeine and subsequently developed right hemiparesis and dysarthria. Brain computed tomography (CT) and digital subtraction angiography (DSA) are shown, respectively, in Figures 1A and 1B. Transcranial doppler (TCD) showed indirect signs of vasospasm. Symptoms subsided after 10 days. Follow-up eight-week magnetic ressonance angiography (MRA) and TCD were normal, as well as twelve-week DSA (Figure 1C). The diagnosis was reversible cerebral vasoconstriction syndrome associated with unusual putaminal hemorrhage after caffeine and isometheptene abuse.