Reversible cerebral vasoconstriction syndrome secondary to chronic cocaine abuse: Case report

We describe the case of a 36-year-old male patient with a history of chronic headache who came to the emergency room due to an intense global headache, associated with a tonic-clonic episode and loss of consciousness. A cranial computed tomography revealed subarachnoid hemorrhage without apparent aneurysms and a left temporal hyperdense lesion suggestive of intraparenchymal hematoma on the follow-up computed tomography. Cerebral angiography showed irregularities in the right internal carotid artery, including a pseudoaneurysm and multiple stenoses in pial arteries, which were related to chronic cocaine use. The final diagnosis was reversible cerebral vasoconstriction syndrome, a rare but potentially serious condition, triggered in this case by cocaine use. Early diagnosis, through imaging studies such as cerebral angiography, is crucial to prevent serious complications like hemorrhages or ischemic events. This case highlights the importance of imaging in the diagnosis of reversible cerebral vasoconstriction syndrome and its relationship with triggers such as sympathomimetic drugs.