Call-Fleming syndrome
A 30-year-old Indian male presented with acute onset of orbito-frontal throbbing headache, which the patient described as the worst pain in his life. There was no photophobia or nausea associated. The pain was not relieved with positional change or on taking medications (acetaminophen). He had no similar history prior to this. On examination, his vitals were found to be stable. He did not have any neurological deficits.\nMagnetic resonance imaging (MRI) brain was done which demonstrated hyperintensity involving right precentral and superior frontal sulci on the fluid-attenuated inversion recovery (FLAIR) axial sequence []. Rest of the cisterns and sylvian fissures were normal. There were no altered parenchymal intensities, areas of restricted diffusion, or parenchymal hemorrhage.\nFurther, a magnetic resonance angiogram (MRA) was done which showed multiple areas of vasospasm involving the supraclinoid segment of internal carotid artery (ICA), M1 segment of middle cerebral artery, A1 segment of anterior cerebral artery on the right side [], and the A1 segment of anterior cerebral artery on the left side. These findings were reconfirmed with cerebral angiogram under digital subtraction angiography (DSA) [Figures and ].\nThe laboratory investigations including CSF analysis were found to be inconclusive. Based on the imaging findings, a provisional diagnosis of RCVS was put forth and the patient was put on Nimodipine 30 mg, 3 times daily. The follow-up MRI which was taken 8 weeks later showed complete resolution of the above-mentioned findings []. This confirmed the diagnosis of RCVS.\nOn a detailed history taking and evaluation, the patient was found to have no other co-morbidities and was not on any medications. Hence, the final diagnosis of Call–Fleming syndrome was made.