Call-Flemings syndrome

Reversible angiitis multifocal postpartum, multiple transient symptoms, treat with calcium channel blockers. Notes sertraline was overrepresented in group with vasoconstriction due to this. triptans, cocaine, phenylpropamine, cannabis, esp with alcohol can ppt this. esp in men. Men often had cannabis, women had ssri's. French called it peripartum angiopathy. Also occurs in young girls at menarche and menopause. Also after carotid surgery, hypercalcemia, pheo, eclampsia. History of migraine is common. Emphasized feature is sudden onset thunderclap headache, scattered MRI abnormalities and TCD's show flow abnormalities and can see focal SAH's. "1000x more common than isolated CNS angiitis" (Lou Caplan). Also suggest reperfusion during migraine presenting as thunderclap HA is more important than acknowledged. consider bartelson's with migraine flavor, 2-3 episodes per day for 2 mo and self limited with pleocytosis, get repeated events in same hemisphere, avoid brain bx or give verapamil. See http://neurologyminutiae.blogspot.com/ for a case series with more clinical descriptions.