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The reversible cerebral vasoconstriction syndromes (RCVS) are a group of conditions characterized by reversible segmental constriction and dilatation of cerebral arteries, typically associated with recurrent thunderclap headaches, and often complicated by ischemic or hemorrhagic strokes.1,2 The posterior reversible encephalopathy syndrome (PRES) is another clinical–radiologic syndrome characterized by reversible, posterior-predominant brain edema, usually associated with headache, altered mental status, seizures, and visual symptoms.3 These entities may share pathophysiologic elements.1,–,3 We report a patient with RCVS-PRES overlap syndrome associated with excessive licorice consumption. Knowledge of the pharmacologic effects of licorice may offer insights into the pathophysiology of RCVS and PRES.
Case report.
A 49-year-old woman developed a severe headache reaching peak intensity within seconds. Similar thunderclap headaches recurred twice over the next 2 days and were associated with intermittent loss of central vision. On day 4 after symptom onset, she developed a generalized seizure. She was hypertensive (230/130 mm Hg), and her neurologic examination showed hyperreflexia. Urinalysis and toxicology screen were unremarkable. Brain MRI showed vasogenic edema in the bilateral parieto-occipital regions (figure, A), with underlying regions of brain hemorrhage detected on gradient echo sequences (not shown). Head CT angiogram (CTA) showed smooth, segmental narrowing of multiple intracranial arteries (figure, B), which was confirmed on gold standard transfemoral cerebral angiography (figure, …
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- Licorice-associated reversible cerebral vasoconstriction with PRES
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