Reactions 1315 - 21 Aug 2010

SCitalopram

Reversible cerebral vasoconstriction syndromemanifesting as thunderclap headache: casereport

A 55-year-old man developed reversible cerebralvasoconstriction syndrome (RCVS) manifesting asthunderclap headache (TCH) during treatment withcitalopram.

The man developed severe sudden-onset left occipitalheadache associated with nausea and emesis after jogginga short distance. About 20 minutes later, he presented tothe emergency department and was hospitalised after anon-contrast CT scan showed left parietal-occipital corticalsubarachnoid haemorrhage. Angiography performed7 days later showed intracranial vasospasm, thought to beconsistent with CNS vasculitis.

Corticosteroids were initiated, then tapered. A follow-upcerebral angiography on day 22 showed resolution of theinitial abnormalities. RCVS was the most likely diagnosis.The man returned 3 months after his initial TCH with apersistent daily headache located in the left occipital, andsometimes in the bilateral frontal regions. Substantialphotophobia was also reported. His medications wereinvestigated, and included citalopram [route, dosage andtherapeutic indication not stated] which he had taken for1 week about 5–6 weeks prior to his headache, thenrestarted 6–7 days before TCH. He was also takingverapamil, atorvastatin and metaxalone. He was advised toavoid SSRIs and sympathomimetic drugs, and his verapamildosage was increased. TCH did not recur.Zarkou S, et al. 55-year-old man with thunderclap headache. Mayo ClinicProceedings 85: e44-e47, No. 7, Jul 2010. Available from: URL: http://dx.doi.org/10.4065/mcp.2009.0372 - USA 803033781

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Reactions 21 Aug 2010 No. 13150114-9954/10/1315-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved