Reversible Cerebral Vasoconstriction Syndrome Responsive to Intravenous Milrinone

NCJ_cover.jpgBy Maximiliano A. Hawkes, Alejandro A. Hlavnicka, Nestor A. Wainsztein

First Online: 30 September 2019

Reversible cerebral vasoconstriction syndrome (RCVS) causes reversible multifocal constriction of cerebral arteries. It is triggered by several conditions, including vasoactive medications, postpartum, migraine, hypertension, and arterial dissection [1]. Suspension of the precipitating agent, supportive care, and oral calcium channel blockers are the mainstay of treatment for most patients [2]. However, the development of refractory vasospasm, ischemic stroke, or intracerebral hemorrhage (ICH) may require further interventions, including intravenous (IV) or intra-arterial vasodilators and balloon angioplasty [2]. Yet, evidence for all these treatment options is weak and is based on case reports, case series, and expert’s opinion. We report a case of severe postpartum RVCS complicated by ICH successfully treated with IV milrinone infusion.

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