COVID-19 Associated Reversible Cerebral Vasoconstriction Syndrome Successfully Treated with Nimodipine and Aspirin

Abstract

There have been limited cases linking SARS-CoV-2 infection with the development of reversible cerebral vasoconstriction syndrome (RCVS). We hereby report a rare case of RCVS in the setting of mild SARS-CoV-2 respiratory infection successfully treated with nimodipine and aspirin. SARS-CoV-2 attacks the ACE2-receptors, which are expressed in various body organs including the lungs, kidneys, and blood vessels. Vasoconstriction can result from down-regulation of the ACE2-receptors that can lead to sympathetic hypertonia of the cerebral blood vessel walls and/or over-activation of the renin-angiotensin axis.

Keywords: Aspirin; COVID-19; Nimodipine; Posterior reversible encephalopathy syndrome; Reversible cerebral vasoconstriction syndrome; SARS-CoV-2.

Fig. 1

MRI shows areas of subcortical white matter and cortical T2/FLAIR-prolongation, notably involving the superior frontal lobes, posterior right and left territories (arrows) (A-D) CT-Angiogram shows basilar arteriospasm (beading-pattern) (E). Diagnostic Cerebral Angiogram shows resolution of the arteriospam (F).