Reactions 1277 - 7 Nov 2009

SCitalopram

Aggravation of cerebral vasoconstriction?: casereport

A 28-year-old woman with thunderclap headache andreversible cerebral vasoconstriction syndrome,experienced an ischaemic stroke; the authors suggest thatcitalopram may have aggravated the cerebralvasoconstriction.

The woman, who was receiving ethinylestradiol/desogestrel, was admitted because of severe thunderclapheadache arising from the back of her neck and nausea. Hersevere headache persisted for 12 hours. She haddepressive symptoms; citalopram 20mg [frequency notstated] and etodolak [sic] were prescribed. She wasdischarged with a diagnosis of primary thunderclapheadache. Her symptoms improved, but she had acontinuous moderate headache. After 7 days, sheexperienced left hemiparesis and was hospitalised. Anexamination confirmed left hemiparesis, lefthemihypoaesthesia and left central facial paralysis.Babinski sign was positive on the left side. A brain MRIrevealed acute ischaemia within the right centrumsemiovale and MR angiography revealed multiple stenoticsegments in the anterior and posterior circulations,especially in the right arteria cerebri media. Ischaemiccerebrovascular disease was diagnosed.

Citalopram and ethinylestradiol/desogestrel werediscontinued and the woman received aspirin. Digitalsubtraction angiography (DSA) revealed multiple segmentsof narrowing in vessel calibre. She received verapamil andaspirin for probable reversible cerebral vasoconstrictionsyndrome. Follow-up MR angiography after 4 weeks andDSA after 7 weeks showed an improvement in thealternating stenoic areas in vessels. Hence, reversiblecerebral vasoconstriction syndrome was confirmed.

Author comment: The medical history of oralcontraceptive use for 5 years and citalopram for 5 days wereevaluated as important risk factors. In our case reversiblecerebral vasoconstriction syndrome was spontaneous . . .SSRIs should be avoided in patients diagnosed withthunderclap headache of unknown etiology or "idiopathicthunderclap headache". Perhaps citalopram aggravated thecerebral vasoconstriction.Oz O, et al. Reversible cerebral vasoconstriction syndrome: case report. Journal ofHeadache and Pain 10: 295-298, No. 4, Aug 2009 - Turkey 801154346

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Reactions 7 Nov 2009 No. 12770114-9954/10/1277-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved