Cerebral Infarction and Cortical Subarachnoid Hemorrhage Preceded Vascular Contraction in Reversible Cerebral Vasoconstriction Syndrome Patient with Hidden Breast Cancer

Thunderclap headaches, stroke, seizures, and cortical subarachnoid hemorrhage can all reveal reversible cerebral vasoconstriction syndrome (RCVS). Most parenchymal brain lesions occur simultaneously and sequentially with cerebral vasoconstriction in RCVS patients. Therefore, it is not easy to suspect RCVS in patients with only parenchymal brain lesions without vasoconstriction even if they present with a typical thunderclap headache. Furthermore, RCVS should be differentiated from central nervous system vasculitis. However, it is especially difficult to distinguish RCVS from the cerebral involvement of multisystem vasculitis when there is a positive result in the serologic test for autoantibodies. We report a case of RCVS with hidden breast cancer in which ischemic stroke and cortical subarachnoid hemorrhage were observed earlier than vasoconstriction, and there were positive autoantibodies.