CLINICAL-NEUROLOGICAL, NEUROIMAGING, AND DIAGNOSTIC FEATURES OF CALL-FLEMING SYNDROME

Call-Fleming syndrome, or reversible cerebral vasoconstriction syndrome (RCVS), is a clinico-radiological syndrome characterized by thunderclap headache, segmental or multifocal narrowing of the intracranial arteries, and their regression over time [1–4]. In practice, diagnosis is often delayed because of the polymorphic clinical course of the syndrome, its similarity to other cerebrovascular and headache syndromes, and the fact that early neuroimaging does not always provide clear confirmation [4–6].

The aim of this study was to evaluate clinical-neurological signs, trigger factors, neuroimaging and paraclinical findings, conformity with diagnostic criteria, and outcomes of clinical management in patients with Call-Fleming syndrome. The study was conducted as a prospective, single-center, observational cohort. Between 2023 and 2025, 30 patients diagnosed with or clinically suspected of having Call-Fleming syndrome were followed in the 1st and 2nd Neurology Departments of the Andijan State Medical Institute Clinic. The results showed that 76.7% of patients were women, and postpartum cases accounted for 30.0%. Thunderclap headache occurred in 96.7% of cases, segmental or multifocal vasoconstriction in 80.0% of patients, and reversibility was documented in 73.3%.

Among trigger factors, vasoactive/serotonergic drugs (40.0%) and postpartum/hormonal factors (30.0%) were predominant. Full conformity with diagnostic criteria was found in 70.0%, partial conformity in 20.0%, and suspected cases accounted for 10.0%. Conservative treatment based on nimodipine predominated, and overall complete clinical regression was recorded in 66.7% of patients [15–18]. These findings indicate that targeted identification of triggers, detection of vasoconstriction using MRA/CTA, and dynamic follow-up are crucial for the early diagnosis of Call-Fleming syndrome.