Disclosures: Caitlin Hartsgrove, MD: No financial relationships or conflicts of interest

Case Description: The patient presented to acute care hospital after seizure-like activity witnessed by roommate, which started after patient was vaping marijuana. Of note, the patient was maintained on paroxetine for depression and wellbutrin had been added 1 week prior to presumed seizure. Upon admission, CT head was negative. MRI showed acute-subacute infarcts in the right cerebellum, left vermis, bilateral thalami, and right posteromedial temporal lobe with extension to occipital lobe. He was thereafter transferred to another acute care hospital for possible neurosurgical intervention. He was found to have basilar artery occlusion and subsequently underwent thrombectomy with intra-arterial calcium channel blocker administration. Interventional angiography revealed luminal irregularity of basilar artery, irregular diffuse narrowing of bilateral posterior cerebral arteries, and diffuse narrowing of left internal carotid artery. Complete stroke work up was otherwise negative.

Setting: Acute inpatient rehabilitation

Patient: 20-year-old male with history of depression Assessment/

Results: The patient was hospitalized for 21 days prior to discharge to acute inpatient rehabilitation, at which time the patient had weakness in all extremities, dysmetria, and was unable to ambulate. At time of discharge from acute rehabilitation, the patient was ambulating with close supervision, carrying out simple calculations, and performing activities of daily living independently.

Discussion: The patient was ultimately diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) given interventional angiography findings, which was thought to be provoked by the recent addition of an anti-depressant agent, wellbutrin.

Conclusion: Though classically described in females with multiple thunderclap headaches generally without significant sequelae, it is important to keep RCVS on the differential diagnosis of a stroke patient, even without the hallmark symptoms if in the setting of a recent vasoactive trigger.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/atypical-presentation-of-reversible-cerebral-vasoconstriction-syndrome-as-etiology-of-stroke-in-a-young-patient-a-case-report/