RCVS in a Person with Prolactinoma: Is Cabergoline the Felon?
Faisal S. Alqahtani1, Nouran Taher2, Jnadi Madkhali3
1College of Medicine, 2Department of Neurology, 1 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia  2 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia  3 Department of Neurology, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia, 3King Abdulaziz Medical City
Objective:

We aimed to report a case of reversible cerebral vasoconstriction syndrome (RCVS) possibly precipitated by cabergoline.

Background:
RCVS is characterized by recurrent thunderclap headaches, with or without other acute neurological manifestations, and segmental constriction of cerebral arteries that resolves spontaneously within 3 months. It is attributed to a transient disturbance in the control of cerebrovascular tone, mainly from exposure to sympathomimetic drugs and the postpartum state. Although it can be associated with major sequelae, there are still unrecognized sporadic classes of drug-induced reversible cerebral vasoconstriction syndrome. Cabergoline-induced RCVS is extremely rare and reported once only in the literature. Here, we report the second case of RCVS after recent exposure to cabergoline due to prolactinoma.
Design/Methods:
NA
Results:

We report a 27-year-old single woman known to have had prolactinoma for 7 years and migraine without aura improved with over-the-counter oral analgesia. 3 days prior to current presentation, she was seen in gynecology clinic with irregular periods and high prolactin, so cabergoline was prescribed with the dose of 0.5 mg orally once a week. She suddenly developed thunderclap headache and 1st two episodes of seizure preceded by chest pain, sweating, dizziness, and non-bloody vomiting on the third day of exposure to cabergoline. Upon ER arrival, the patient was conscious, awake, alert, oriented, and hemodynamically and clinically stable. Neurologic examination was normal. CT brain demonstrated left frontal intra-parenchymal bleeding up on patient presentation. The first cerebral DSA revealed segmental constriction and dilatation of multiple median and small sized arteries. Although (DSA) revealed medium arteries irregularities, follow up DSA finding after cabergoline discontinuation showed complete remission of the stenosis. Moreover, she recovered without any neurological symptom other than mild headache controlled by amitriptyline.

Conclusions:

Cabergoline should be recognized as a potential trigger of RCVS, and close monitoring is important to avoid possible life-threatening complications of RCVS.

10.1212/WNL.0000000000205305