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A 40-year-old woman developed reversible cerebral vasoconstriction syndrome (RCVS) with heart failure, angioedema and coronary artery spasm (cardiac involvement) during treatment with iron for iron deficiency anaemia. Subsequently, the RCVS exacerbated during treatment with prednisolone and methylprednisolone for presumed acute demyelinating encephalomyelitis [not all dosages and routes stated; duration of treatments to reaction onset not stated].
The woman experienced a severe headache early in the morning and presented to her nearby neurosurgical hospital. During consultation with neurologist, she had a generalised convulsion starting from her right upper limb. She was treated with diazepam, and brain MRI showed high-intensity lesions bilaterally in the cerebellar hemispheres, and near the right caudate nucleus on fluidattenuated inversion recovery (FLAIR) images. Her WBC count was elevated, but with no evidence of infectious disease. Cell count increase was not observed on CSF analysis, but CSF protein was slightly increased. Initially, an acute demyelinating encephalomyelitis was suspected, and she was treated with methylprednisolone 1000mg along with phenytoin. Her headache resolved and walking improved the next morning, and she was...