Reversible Cerebral Vasospasm in Acute Intermittent Porphyria: A Case Report and Review of the Literature

The porphyrias are rare inherited diseases of heme biosynthesis which can involve the nervous system. The most common neurological manifestations of acute intermittent porphyria are autonomic visceral neuropathy, peripheral motor neuropathy, and central nervous system dysfunction. In rare cases, patients with acute intermittent porphyria have presented with cerebral infarction, suggested to be due to vasospasm in cerebral arteries. We report a case of reversible vasospasm in porphyric encephalopathy demonstrated by both magnetic resonance and conventional angiography. Unexplained abdominal pain occurred before the onset of neurological symptoms. LEARNING POINTS: Acute intermittent porphyria can affect the central nervous system. Abdominal pain with neurological symptoms should prompt consideration of porphyria. Cerebral vasospasm is implicated in the pathogenesis of cerebral infarction. Heme arginate is the treatment of choice for central nervous system injury.