Reactions 1509, p14 - 12 Jul 2014

SCitalopram/escitalopram

Fulminant reversible cerebral vasoconstrictionsyndrome: 2 case reports

Two women with serotonin syndrome developed fulminantreversible cerebral vasoconstriction syndrome (RCVS) whilereceiving escitalopram or citalopram for depression [dosages,routes and times to reaction onset not stated].

A 45-year-old woman was receiving escitalopram. Shepresented with thunderclap headache and confusion. She wastreated with dihydroergotamine mesilate andhydromorphone, and brain MRI revealed T2 hyperintensitiesresembling posterior reversible encephalopathy syndrome.Two days later, MRI found a focal T2 hyperintensity in thefrontal subarachnoid space consistent with a bleed. Ten daysafter symptom onset, she became comatose with decerebrateposturing. Repeat imaging revealed large bihemisphericinfarcts with significant oedema. Cerebral angiogram showedsevere segmental vessel narrowing. She received verapamiland nicardipine treatment with minimal improvement.Aggressive management of intracranial pressure wasunsuccessful, and worsening imaging led to withdrawal ofcare.

A 57-year-old woman was receiving citalopram; her dosehad recently been increased. She was admitted with dizziness,and she developed acute confusion followed by seizure andunresponsiveness. She was rigid, diaphoretic, febrile andtachycardic. She subsequently developed decerebrateposturing. Brain MRI and CT found bilateral parieto-occipitalstrokes. Cerebral angiogram showed severe diffuseirregularities in posterior circulation. She received verapamil,and nicardipine was administered with slight improvement.Eight days after symptom onset, angiogram showedimprovement of vasoconstriction. She was later discharged.

Author comment: "Serotonergic agents are known triggersof RCVS".John S, et al. Catastrophic reversible cerebral vasoconstriction syndrome associatedwith serotonin syndrome. Cephalalgia 33 (Suppl.): 287-288 abstr. P431, No. 8, Jun2013. Available from: URL: http://doi.org/10.1177/0333102413490487 -USA 803105716

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Reactions 12 Jul 2014 No. 15090114-9954/14/1509-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved