Possible Reversible Cerebral Vasoconstriction Syndrome Associated With Eucalyptus: Case Report

Abstract: Background: Reversible cerebral vasoconstrictive syndrome (RCVS) is clinically characterized by a sudden onset thunderclap-like headache or severe headache over a few weeks which can be confirmed by radiological imaging showing areas of ischemia or subarachnoid hemorrhage confined to convexity. The majority of RCVS cases are associated with use of antidepressants, polysubstance abuse and nasal decongestants. We here present a case that highlights the use of eucalyptus herbs as a possible precipitant factor for RCVS formation. Case Presentation: A 42 year-old woman presented to the emergency department with a tingling sensation on the right side of her body and a two-week progressive throbbing severe holocranial headache radiating to the neck, with associated nausea, photophobia, and phonophobia. She denied any seizures and recent trauma or fevers. She was not taking scheduled medications, but she had used inhaling vapors obtained from boiling eucalyptus leaves to alleviate sinus congestion. Initial imaging revealed subarachnoid hemorrhage at bilateral posterior parietal convexity leading to her admission into the Intensive Care Unit (ICU). Further work up disclosed the presence of findings consistent with RCVS. Conclusion: In conclusion, we hereby postulate that some herbal remedies used in alternative medicine, including eucalyptus could play a role in causing serotonergic symptoms including dizziness, diarrhea, and cerebral vasoconstriction. Understanding that eucalyptus has the potential to contribute to RCVS due to its serotoninergic activity may be of importance in the diagnosis and management of these patients.