Call–Fleming syndrome associated with subarachnoid haemorrhage: three new cases
- Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
- Professor J-C Baron, University of Cambridge, Department of Clinical Neurosciences, Neurology Unit, Addenbrooke’s Hospital, Box 83, Cambridge CB2 2QQ, UK;
- Received 10 September 2007
- Revised 9 November 2007
- Accepted 18 November 2007
- Published Online First 12 December 2007
Background: The Call–Fleming syndrome (CFS) comprises acute severe recurrent (thunderclap) headaches, occasional transient or fluctuating neurological abnormalities and reversible segmental cerebral vasoconstriction. It is a benign condition with an excellent prognosis, yet because it is often clinically and radiologically similar to a number of commonly encountered conditions, diagnostic difficulties may arise, leading to inappropriate, and even potentially harmful, investigative and therapeutic approaches.
Cases: Three personal cases are presented to highlight the occurrence of subarachnoid haemorrhage (SAH) as part of CFS. In two patients with a positive CT head, SAH involved the sulci in the upper cerebral convexity, an unusual location in aneurysmal SAH.
Results: SAH is not an uncommon feature of CFS, occurring in approximately 25% of reported cases, and may pose a diagnostic challenge. CFS has a relatively characteristic spectrum of features, allowing a confident diagnosis in most cases, even when atypical features such as SAH are present.
Conclusions: Recognising the spectrum of abnormalities seen in CFS, including particularly SAH, allows a sound approach to a safe diagnosis.
Competing interests: None.
Ethics approval: Ethics approval was obtained.