Pediatric RCVS in Newly Diagnosed all Treated with Intra-Arterial Nicardipine

Abstract

Background: Reversible Cerebral Vasoconstriction Syndrome (RCVS) is an uncommon cause of severe headache and other complications in the pediatric population. Diagnosis includes obtaining vessel imaging to confirm vasospasm in the cerebral vasculature. Therapy oftentimes requires calcium channel blockers administered through an intra-arterial approach. Resolution of symptoms and vasospasm are expected at approximately 3 months. Case description: We report a case of RCVS in a 3-year-old male who was admitted to the pediatric ICU with newly diagnosed Acute Lymphoblastic Leukemia (ALL). Hospital course was complicated by acute neurologic decline and evidence of severe cerebral vasospasm resulting in multiple ischemic strokes. Course of treatment required hospital transfer for intra-arterial calcium channel blocker therapy with eventual resolution of cerebrovascular constriction and improvement in clinical exam. Conclusion: When pediatric patients develop acute onset severe headaches, consideration of a broad differential diagnosis is important, and recognition of RCVS early in the hospital course can profoundly alter management and treatment options.