During  soccer practice a fifteen year old girl experienced a sudden onset of pain in the left side of her neck and collapsed. Upon arrival at the emergency room she had right hemiparesis and expressive aphasia. On CT angiography a left carotid arterial dissection was suspected. Symptoms improved during the first threedays but worsened again on the fourth and a CT scan showed an ischemic area in the brain. Conventional angiography showed decreased perfusion in the left middle cerebral artery but no evidence of dissection or thrombus. The most likely diagnosis was thought to be reverse cerebral vasoconstriction syndrome and the girl was treated with calcium channel inhibitors. Here we report the case and review the literature.

Figure 1. CT angiography of brain showing occlusion of the internal carotid artery.

Figure 2. MRI of brain (T2 sequence) showing slight edema in the left insula and putamen.

Figure 3. CT of brain showing an infarct in the left temporoparietal region.

Figure 4. Cerebral angiography showing decreased perfusion posteriorly in the vascular territory of the left middle cerebral artery.

Figure 5. MRI (diffusion imaging) of brain showing decreased diffusion in the insula, putamen and temporal cortex in the left hemisphere.

Table I. Previous names for RCSV¹⁰

Table II. Diagnostic criteria⁶