[Reversible segmental cerebral vasoconstriction: the value of duplex transcranial Doppler in its diagnosis and follow up]. / Vasoconstriccion segmentaria cerebral reversible: utilidad del duplex transcraneal en el diagnostico y seguimiento.

INTRODUCTION: Reversible segmental cerebral vasoconstriction, also known as Call Fleming syndrome, is a clinical entity that consists of segmental vasoconstriction of the arteries in the brain, which can course with focal neurological deficits and which is characteristically reversible. Diagnosis and follow up of reversible segmental cerebral vasoconstriction is performed using cerebral arteriography, but no previous evaluation has been conducted of the role that duplex transcranial Doppler can play in this syndrome. CASE REPORT: Here we describe the case of a 57 year old female patient who began suffering from sudden bouts of headaches with no other accompanying clinical features. After ruling out the possibility of a subarachnoid haemorrhage by means of a spinal tap, a suspicion diagnosis of reversible segmental cerebral vasoconstriction was made through duplex transcranial Doppler and this was later confirmed by arteriography, which revealed a segmental stenosis in the upper branch of the left middle cerebral artery. Following treatment with nimodipine, the patient presented a clear clinical improvement and the reversibility of the cerebral vasoconstriction was confirmed by duplex transcranial Doppler. CONCLUSION: Contrast enhanced duplex transcranial Doppler would enable us to obtain an early diagnostic approximation in patients in whom segmental vasoconstriction is suspected; it could also constitute the choice non invasive follow up method in these patients.

Vasoconstricción segmentaria cerebral reversible: utilidad del dúplex transcraneal en el diagnóstico y seguimiento / Reversible segmental cerebral vasoconstriction: the value of duplex transcranial doppler in its diagnosis and follow-up

Introducción. La vasoconstricción segmentaria cerebral reversible, también conocida como síndrome de Call-Fleming, es una entidad clínica consistente en una vasoconstricción segmentaria de las arterias cerebrales. Puede cursar con déficit neurológicos focales y es característicamente reversible. El diagnóstico y seguimiento de la vasoconstricción segmentaria cerebral reversible se realiza mediante arteriografía cerebral, pero el papel del estudio dúplex transcraneal en dicho síndrome no se ha valorado previamente. Caso clínico. Presentamos el caso de una paciente de 57 años que debuta con una cefalea de inicio súbito sin otra clínica acompañante. Tras descartar mediante punción lumbar una hemorragia subaracnoidea, se realiza el diagnóstico de sospecha de vasoconstricción segmentaria cerebral reversible mediante un estudio dúplex transcraneal, confirmada posteriormente por arteriografía al objetivar una estenosis segmentaria en la rama superior de la arteria cerebral media izquierda. Tras iniciar el tratamiento con nimodipino, la paciente presenta una clara mejoría clínica y se confirma mediante el estudio dúplex transcraneal la reversibilidad de la vasoconstricción cerebral. Conclusión. El dúplex transcraneal potenciado con contraste permitiría una primera aproximación diagnóstica en los pacientes con sospecha de vasoconstricción segmentaria, y podría constituir el método de seguimiento no invasivo de elección en estos pacientes (AU)

Introduction. Reversible segmental cerebral vasoconstriction, also known as Call-Fleming syndrome, is a clinical entity that consists of segmental vasoconstriction of the arteries in the brain, which can course with focal neurological deficits and which is characteristically reversible. Diagnosis and follow-up of reversible segmental cerebral vasoconstriction is performed using cerebral arteriography, but no previous evaluation has been conducted of the role that duplex transcranial Doppler can play in this syndrome. Case report. Here we describe the case of a 57-year-old female patient who began suffering from sudden bouts of headaches with no other accompanying clinical features. After ruling out the possibility of a subarachnoid haemorrhage by means of a spinal tap, a suspicion diagnosis of reversible segmental cerebral vasoconstriction was made through duplex transcranial Doppler and this was later confirmed by arteriography, which revealed a segmental stenosis in the upper branch of the left middle cerebral artery. Following treatment with nimodipine, the patient presented a clear clinical improvement and the reversibility of the cerebral vasoconstriction was confirmed by duplex transcranial Doppler. Conclusion. Contrast-enhanced duplex transcranial Doppler would enable us to obtain an early diagnostic approximation in patients in whom segmental vasoconstriction is suspected; it could also constitute the choice non-invasive follow-up method in these patients (AU)