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Minerva

Nasal decongestants and reversible cerebral vasoconstriction

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5112 (Published 03 January 2019) Cite this as: BMJ 2019;364:k5112
  1. Christopher Pollard, ST5 radiology1,
  2. Fozia Nazir, consultant neurologist2,
  3. Ravi Jampana, consultant neuroradiologist1
  1. 1Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
  2. 2Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
  1. Correspondence to C Pollard c4rispollard{at}gmail.com

A 57 year old woman experienced six days of daily thunderclap headaches, which spontaneously resolved. Computed tomography showed a small volume of peripheral subarachnoid haemorrhage, and computed tomography angiography showed “possible vasculitis.”

Magnetic resonance angiography (MRA) (fig 1) showed multifocal cerebral artery narrowing (arrows) and no aneurysm. Cerebrospinal fluid protein was normal, making inflammatory vasculitis unlikely.

Further history revealed that the first thunderclap headache had occurred three days after finishing a one week course of nasal decongestants for an upper respiratory tract infection.

MRA two months later was normal.

Spontaneously resolved recurrent thunderclap headaches with abnormal imaging are typical for reversible cerebral vasoconstriction syndrome.

Causes include cannabis, selective serotonin re-uptake inhibitors, triptans, diet pills, and postpartum changes. This case was attributed to nasal decongestant use.

Footnotes

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