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Call–Fleming syndrome associated with subarachnoid haemorrhage: three new cases
  1. R R Moustafa,
  2. C M C Allen,
  3. J-C Baron
  1. Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
  1. Professor J-C Baron, University of Cambridge, Department of Clinical Neurosciences, Neurology Unit, Addenbrooke’s Hospital, Box 83, Cambridge CB2 2QQ, UK; jcb54{at}


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.

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  • Competing interests: None.

  • Ethics approval: Ethics approval was obtained.