Diffuse cerebral vasoconstriction (Call–Fleming syndrome) and stroke associated with antidepressants

Abstract

Call-Fleming syndrome is a reversible segmental vasoconstriction of cerebral arteries manifested by a "thunderclap" headache and focal neurologic symptoms. Although of unknown etiology, it has been reported in association with vasoactive sympathomimetic drugs. The authors report Call-Fleming syndrome in two patients with history of antidepressant use. Although the association is hypothetical, the authors suggest consideration of Call-Fleming syndrome in patients presenting with headache, focal deficits, and evidence of cerebral ischemia during antidepressant use.

Cognitive Deterioration After Venlafaxine Overdose

“…Another possible origin of this patient's clinical picture could be related to venlafaxine's vasospastic effect (CallFleming Syndrome). This occurs with other SSRIs, and can be the cause of lesions such as embolisms, bleeding, or edema detectable in neuroimaging tests; however, none of these occurred in our patient (27)(28)(29). Another possibility is the known and described cardiotoxicity of venlafaxine (2)(3)(4).…”

Reversible cerebral vasoconstriction syndrome presenting with haemorrhage

“…Another small series of RCVS in the post-partum context included one patient with a small subarachnoid overlying the right frontal cortex [15]. In sixteen individual case reports reviewed with RCVS, haemorrhage was found in four whilst ischaemic changes were found in twelve [4,5,16]. The four further cases we describe may help increase clinical vigilance regarding this condition, decreasing the likelihood of mis-diagnosing cerebral vasculitis and misusing aggressive and toxic immunosuppressive drugs.…”

“…The fourth patient was taking venlafaxine and salbutamol, and was a regular user of cannabis -the latter also a recognised precipitant [2]. Antidepressant serotoninergic drugs have been implicated a cause of this syndrome [4,5]. All four patients improved without any immunosuppressive therapy, three after receiving nimodipine -which some consider the best option in RCVS [6][7][8].…”

Medical Complications of Psychiatric Treatment

“…Although more data are needed to clarify this situation, management of agitation and behavioral disturbances in the medically ill elderly with dementia is currently best served by weighing the risks of treatment with the risks of ongoing behavioral disturbance (taking into account alternative treatment strategies and the underlying risk factors for cerebrovascular accident) [19]. Finally, several case reports have suggested an association between serotonergic antidepressants and the so-called ''Call-Fleming syndrome'' (diffuse cerebral vasoconstriction) leading to stroke [20,21]. Although this comprises merely an association, any patient who presents with the hallmark symptoms of Call-Fleming (ie, severe headache and focal deficits with evidence of cerebral ischemia or vasoconstriction) merits a thorough review of medications that enhance serotonergic transmission.…”