30 year old male presented with severe, sudden onset of throbbing orbito-frontal thunderclap headache
FLAIR axial images show focal subarachnoid hemorrhage – blood in the precentral and superior frontal sulci (arrow). The cisterns and Sylvian fissures are free of blood.
DIAGNOSIS : Call Fleming Syndrome
DISCUSSION : Thunderclap headache is most commonly seen secondary to subarachanoid haemorrhage (SAH), the various other causes are cerebral vasculitis, carotid artery dissection, cerebral dural venous thrombosis and pituitary apoplexy and Reversible cerebral vasoconstriction syndrome (RCVS).
Call Fleming Syndrome, is an idiopathic part of the spectrum of reversible cerebral vasoconstriction syndrome (RCVS), which is a clinic-radiological entity, encompassing a large group of conditions which are characterized by, as the name suggests, intracerebral vascular spasms that are reversible. The classical radiological presentation is that of multi-segmental vasospasm in the vessels of the circle of Willis. The post-stenotic areas classically show dilatation. The resolution of this occurs within 8 to 12 weeks.