Reversible Cerebral Vasoconstriction Syndrome Responsive to Intravenous Milrinone

Abstract

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. 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. 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.