{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T06:27:30Z","timestamp":1761632850132,"version":"build-2065373602"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"\n Background<\/jats:title>\n Reversible cerebral vasoconstriction syndrome (RCVS) is a rare but severe neurovascular complication following cardiac transplantation. Its diagnosis is often complicated by atypical presentations and by neuroimaging limitations, as transplant-related devices can hinder timely magnetic resonance (MR) imaging.<\/jats:p>\n <\/jats:sec>\n \n Case presentation<\/jats:title>\n A 59-year-old woman developed a severe headache 9 days post-cardiac transplantation. Neurological examination revealed left lower quadrantanopia. A head Computed Tomography (CT) scan showed a subdural hematoma, along with a subcortical and convexity subarachnoid hemorrhage in the right parieto-occipital lobe. Initial CT angiography showed only focal arterial stenosis. On day 10, she developed left hemineglect. After removal of transplant-related devices, MR imaging showed a watershed infarct and MR angiography revealed multiple vasospasms.<\/jats:p>\n <\/jats:sec>\n \n Diagnostic challenges<\/jats:title>\n The diagnostic challenge was the delayed onset of diffuse vasospasms, the confirmation of which was precluded by the initial contraindication to MR imaging.<\/jats:p>\n <\/jats:sec>\n \n Management<\/jats:title>\n The patient was diagnosed with RCVS. Management included withdrawal of tacrolimus and initiation of oral verapamil and prasugrel. This led to rapid clinical and radiological improvement.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This case highlights that RCVS can present with a subdural hematoma before the onset of delayed vasospasm after cardiac transplantation. Repeated cerebrovascular evaluations are crucial for timely diagnosis and management in post-transplant patients with unexplained headaches or intracranial hemorrhage.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fcvm.2025.1660432","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T06:24:46Z","timestamp":1761632686000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reversible cerebral vasoconstriction syndrome with delayed vasospasms and subdural hematoma after cardiac transplantation: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Shuhei","family":"Egashira","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tasuku","family":"Hada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satsuki","family":"Fukushima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasumasa","family":"Tsukamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masatoshi","family":"Koga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Toyoda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"6897","DOI":"10.1007\/s12035-015-9560-0","article-title":"Posterior reversible encephalopathy syndrome after transplantation: a review","volume":"53","author":"Chen","year":"2016","journal-title":"Mol Neurobiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1016\/j.healun.2016.01.1221","article-title":"Two rare neurologic complications after heart transplantation: posterior reversible encephalopathy syndrome, followed by reversible cerebral vasoconstriction syndrome","volume":"35","author":"Park","year":"2016","journal-title":"J Heart Lung Transplant"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e16246","DOI":"10.1111\/ene.16246","article-title":"Frequency of ischaemic stroke and intracranial haemorrhage in patients with reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES)\u2014a systematic review","volume":"31","author":"Kaufmann","year":"2024","journal-title":"Eur J Neurol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1002\/ana.21951","article-title":"Magnetic resonance angiography in reversible cerebral vasoconstriction syndromes","volume":"67","author":"Chen","year":"2010","journal-title":"Ann Neurol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"S2772-3747(25)00395-3","DOI":"10.1016\/j.jacasi.2025.07.020","article-title":"CYP2C19 Polymorphism and clopidogrel efficacy in long-term outcomes of large-artery atherosclerotic stroke: the NCVC genome registry","author":"Yoshimoto","year":"2025","journal-title":"JACC Asia"},{"key":"B6","doi-asserted-by":"publisher","first-page":"505","DOI":"10.4103\/aian.aian_614_24","article-title":"Neurotoxicity of calcineurin inhibitors","volume":"28","author":"Bajon","year":"2025","journal-title":"Ann Indian Acad Neurol"},{"key":"B7","first-page":"609","article-title":"Neuroendocrine response to cardiac transplantation","volume":"9","author":"Masters","year":"1993","journal-title":"Can J Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1007\/s00415-020-10193-y","article-title":"Hemorrhagic reversible cerebral vasoconstriction syndrome: a retrospective observational study","volume":"268","author":"Patel","year":"2021","journal-title":"J Neurol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2505","DOI":"10.1161\/STROKEAHA.109.572313","article-title":"Hemorrhagic manifestations of reversible cerebral vasoconstriction syndrome: frequency, features, and risk factors","volume":"41","author":"Ducros","year":"2010","journal-title":"Stroke"},{"key":"B10","doi-asserted-by":"publisher","first-page":"3091","DOI":"10.1093\/brain\/awm256","article-title":"The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients","volume":"130","author":"Ducros","year":"2007","journal-title":"Brain"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1742","DOI":"10.1161\/STROKEAHA.116.013136","article-title":"Hemorrhagic reversible cerebral vasoconstriction syndrome: features and mechanisms","volume":"47","author":"Topcuoglu","year":"2016","journal-title":"Stroke"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1660432\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T06:24:47Z","timestamp":1761632687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1660432\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,28]]},"references-count":11,"alternative-id":["10.3389\/fcvm.2025.1660432"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1660432","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,28]]},"article-number":"1660432"}}