Reversible cerebral vasoconstriction syndrome successfully treated by intrathecal nicardipine

Reversible cerebral vasoconstriction syndrome (RCVS) presents with a thunderclap headache, often prompting brain imaging. Most patients fully recover with supportive care and time, but oral calcium channel blockers are often used in patients with severe vasoconstriction. In this case report, we present a patient with severe vasoconstriction leading to weakness refractory to oral calcium channel blockers. Intrathecal nicardipine was administered via an external ventricular drain and the patient subsequently showed improvement of her weakness and significant improvement of vasospasm on Computed Tomography Angiography. We suggest further studies to determine the efficacy of intrathecal nicardipine in patients with RCVS not responsive to oral calcium channel blockers. •Reversible cerebral vasoconstriction syndrome (RCVS) is an under-diagnosed cause of severe headache.•Oral calcium channel blockers can be used for severe cases.•Intrathecal calcium channel blockers via EVD have been used to treat aneurysmal vasospasm.•Intrathecal nicardipine may be a treatment option for cases of refractory RCVS with neurologic deficit.