Abstract 396: Reversible Cerebral Vasoconstriction Syndrome Following Blood Transfusion: A Rare Case Report

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by multifocal, segmental vasoconstriction of the cerebral vessels that is temporary and occurs suddenly. Typical presentation includes a thunderclap headache and is potentially accompanied by neurological deficits such as stroke‐like symptoms or seizures. Although blood transfusion is an infrequent precipitating factor for RCVS, we report a rare case involving a 37‐year‐old female with a history of menorrhagia secondary to uterine fibroids who developed RCVS following the transfusion of packed red blood cells (pRBC). The patient presented to the emergency department with severe headache, worsening dizziness, and gait instability that led to hitting her head on a wall. She also had dysarthria, as well as left facial droop and left‐sided hemiparesis. She had been discharged one week prior after receiving three units of pRBCs for severe anemia, which improved her hemoglobin levels from below 4 g/dL to 8.3 g/dL. Initial CT imaging revealed acute bifrontal intraparenchymal hematomas, subarachnoid hemorrhage, and subdural hematoma. MRI confirmed intracranial hemorrhage without significantly enhancing lesions, and magnetic resonance arteriography and venography showed no artery closure or venous sinus thrombosis. A cerebral angiogram demonstrated multifocal stenosis of the intracranial vessels, with improved dilation following Verapamil administration, confirming the diagnosis of RCVS. Systemic Verapamil was discontinued due to adverse cardiovascular effects. The patient was discharged to an acute rehabilitation center and showed significant speech and motor function improvement, eventually returning to baseline functionality. This case underscores the importance of considering RCVS in severely anemic patients who develop severe headaches or neurological deficits following blood transfusion. Clinicians should consider this potential complication to ensure timely diagnosis and appropriate management.