{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:07:42Z","timestamp":1791594462956,"version":"4.3.4"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T00:00:00Z","timestamp":1378166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Headache"],"published-print":{"date-parts":[[2013,10]]},"abstract":"\n Objectives<\/jats:title>\n \n To report fulminant cases of reversible cerebral vasoconstriction syndrome (\n RCVS<\/jats:styled-content>\n ) in the setting of serotonin syndrome.\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n \n RCVS<\/jats:styled-content>\n is characterized by acute onset of severe headaches, with or without neurologic deficit, with evidence of reversible cerebral vasoconstriction. It is often benign, and prognosis is generally considered favorable. In the largest prospective study on\n RCVS<\/jats:styled-content>\n , only 4% of patients were disabled from strokes and there were no fatalities.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We report a case series.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We report 2 women with history of depression on selective serotonin re\u2010uptake inhibitors who presented with thunderclap headache and dizziness, respectively. Through the course of hospitalization, both patients developed rigidity, diaphoresis, fever, tachycardia with labile blood pressures and clonus on examination. Since there was a recent addition\/increase in a known serotonergic agent, they met criteria for serotonin syndrome. Cerebrovascular imaging in both patients revealed severe multi\u2010focal vessel narrowing. The first patient developed large bi\u2010hemispheric ischemic infarcts and increased intra\u2010cranial pressure that was refractory to management, and she eventually expired. The second patient developed bilateral parieto\u2010occipital strokes and decerebrate posturing. Her course slowly stabilized, and she was eventually discharged with residual left\u2010sided hemiparesis. Repeat cerebrovascular imaging 1 month later showed normal vessels. In both patients, intra\u2010arterial nicardipine infusion improved angiographic appearance of stenoses, consistent with\n RCVS<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Both cases satisfied the Sternbach criteria for serotonin syndrome. Fatality in case 1 prevents demonstration of reversal of cerebral vasoconstriction, but improvement of arterial diameters with intra\u2010arterial calcium channel blockers in both cases suggests that both had\n RCVS<\/jats:styled-content>\n . Serotonergic agents are known triggers of\n RCVS<\/jats:styled-content>\n , but the concurrent presence of serotonin syndrome likely precipitated the malignant course in our patients. Severe clinical and angiographic manifestations should be considered as part of the spectrum of\n RCVS<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/head.12202","type":"journal-article","created":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T16:54:39Z","timestamp":1378227279000},"page":"1482-1487","source":"Crossref","is-referenced-by-count":34,"title":["Catastrophic Reversible Cerebral Vasoconstriction Syndrome Associated With Serotonin Syndrome"],"prefix":"10.1111","volume":"53","author":[{"given":"Seby","family":"John","sequence":"first","affiliation":[{"name":"Department of Neurology Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Donnelly","sequence":"additional","affiliation":[{"name":"Department of Neurology Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Uchino","sequence":"additional","affiliation":[{"name":"Cerebrovascular Center Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,9,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awm256"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.58.1.130"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102410394673"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.148.6.705"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcg109"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.2005.01063.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.21384"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.21951"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.572313"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2011.68"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A0839"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A0929"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.41.7.1145"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-006-0194-3"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2011.811"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcpc0809063"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000223648.76430.27"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.639575"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.55.5.712"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2010.01.052"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2010.08.004"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.3171\/2010.6.JNS1018"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2202-9-85"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fhead.12202","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.12202","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T09:19:05Z","timestamp":1762075145000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.12202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9,3]]},"references-count":23,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2013,10]]}},"alternative-id":["10.1111\/head.12202"],"URL":"https:\/\/doi.org\/10.1111\/head.12202","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9,3]]}}}