[Reversible cerebral vasoconstriction syndrome secondary to secreting jugular paraganglioma]. / Sindrome de vasoconstriccion cerebral reversible secundario a un paraganglioma yugular secretor de metanefrinas.

TITLE: Sindrome de vasoconstriccion cerebral reversible secundario a un paraganglioma yugular secretor de metanefrinas.

[Reversible cerebral vasoconstriction syndrome associated with anastrozole: an unusual cause of high impact]. / Sindrome de vasoconstriccion cerebral reversible asociado a anastrozol: una causa inusual de alto impacto.

INTRODUCTION: Reversible cerebral vasoconstriction syndrome (RCVS) is a low incidence disability with a multifactorial etiology and a wide array of symptoms. The main symptom is a thunderclap headache, accompanied sometimes with various neurological deficits that can lead to death. RCVS is usually diagnosed through radiological imaging technology. The treatment includes adopting general measures of monitoring, symptomatic management, identifying the etiology and acting on it to avoid recurrence. CASE REPORT: A 71-year-old woman with a history of breast cancer originally treated with tamoxifen. Due to urticaria, the anastrozole management was staggered. She was admitted for aphasia, drowsiness and a thunderclap headache. The patient reported a similar event two weeks prior admission. In brain resonance, there was evidence of small sub-arachnoidal haemorrhage (SAH) of the left parietal temporal convexity and cerebral angiography. As well as documented vasospasm in the posterior parietal region confirming the diagnosis of RCVS plus SAH. During the stay, she presented three events with the same characteristics, requiring intensive monitoring and two therapeutic panangiographies with intra-arterial nimodipine with subsequent resolution of the vessel spasm. The patient remains asymptomatic six months later. CONCLUSION: RCVS is difficult to diagnose given its wide array of symptoms and multifactorial etiology. In this case, RCVS plus SAH is associated with the use of anastrozole. So far there are no reported cases of aromatase inhibitors associated with this pathology and should be reported in the literature for pharmacovigilance.

TITLE: Sindrome de vasoconstriccion cerebral reversible asociado a anastrozol: una causa inusual de alto impacto.Introduccion. El sindrome de vasoconstriccion cerebral reversible (SVCR) es una entidad de baja incidencia, de etiologia multifactorial y amplio espectro de presentacion. El principal sintoma es la cefalea de tipo trueno. Puede estar acompañado de focalizacion neurologica y cursar con desenlaces clinicos variable que incluso pueden llevar a la muerte. El diagnostico es clinico e imaginologico, y el tratamiento incluye adoptar medidas generales de monitorizacion, manejo sintomatico, identificar la etiologia y actuar sobre ella para evitar recurrencia. Caso clinico. Mujer de 71 años con antecedente de cancer de seno, tratada inicialmente con tamoxifeno; por presentar urticaria, se escalono tratamiento con anastrozol. Ingreso por cefalea de tipo trueno, afasia anterior y somnolencia. La paciente refirio un evento similar una semana antes del ingreso. En la resonancia magnetica cerebral evidencio una hemorragia subaracnoidea (HSA) pequeña de la convexidad temporoparietal izquierda, y la panangiografia documento vasoespasmo en la region parietal posterior, lo que confirmo el diagnostico de SVCR mas HSA. Durante el ingreso presento tres eventos de iguales caracteristicas, que requirieron monitorizacion intensiva y dos panangiografias terapeuticas con nimodipino intraarterial, con posterior resolucion del vasoespasmo. Permanece asintomatica seis meses despues. Conclusion. El SVCR constituye un reto diagnostico dada su presentacion variable y su etiologia multifactorial. En este caso, el SVCR mas HSA esta asociado al uso de anastrozol. Hasta el momento no hay casos descritos de inhibidores de la aromatasa asociados a esta patologia, que debe comunicarse para su farmacovigilancia.