Bilateral Cluster Headache-like Attack as a Manifestation of Reversible Cerebral Vasoconstriction Syndrome Following Carotid Artery Stenting: A Case Report

A 34-year-old Japanese man developed bilateral periorbital pain and cranial autonomic symptoms that mimicked cluster headache after carotid artery stenting. Imaging revealed hemorrhagic infarction and multifocal vasoconstriction, confirming reversible cerebral vasoconstriction syndrome (RCVS). He had a history of radiotherapy for nasopharyngeal carcinoma, which likely contributed to the delayed vascular injury, including carotid stenosis and vertebral artery dissection. Combined with procedural stress from stenting, these factors may have triggered the RCVS. This case highlights the importance of considering RCVS in patients presenting with atypical headaches after endovascular intervention, particularly in those with prior radiation exposure. Repeat neuroimaging is crucial for a timely diagnosis.