Reversible Cerebral Vasoconstriction Syndrome Following Exposure to Oleoresin Capsicum “Pepper Spray”

Neeharika Thottempudi, Dmitri Kovalev, Sneh Preet Munder, Hashem Shaltoni, Arun Singh Chhabra, Karthikram Raghuram, Anand V. Patel

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Objectives: To report a case associating the use of Oleoresin Capsicum Pepper Spray (OCPS) during law enforcement training with development of Reversible Cerebral Vasoconstriction Syndrome (RCVS). Materials and Methods: RCVS is radiographically characterized by multifocal smooth narrowing of cerebral arteries heralded by clinical manifestations of recurrent thunderclap headaches. 70% of cases with RCVS have a clear precipitating factor and agents commonly implicated were cannabis, selective serotonin reuptake inhibitors, nasal decongestants, cocaine, postpartum state, eclampsia and strenuous physical/sexual activity.1 Results: 24-year-old female police officer with no past medical history who presented with thunderclap headaches after exposure to pepper spray to her face during work training. Neurological examination was unremarkable. CT angiogram (CTA) of the head and neck and subsequent conventional angiogram revealed multifocal mild arterial narrowing of bilateral middle cerebral arteries (MCA), bilateral posterior cerebral arteries (PCA) and left anterior cerebral artery (ACA) concerning for RCVS. Eight weeks later, she had a repeat MRA head and neck demonstrating complete resolution of the previously noted narrowing of her cerebral arteries. Conclusions: OCPS is widely used in law enforcement training as well as by general population as a self- defense tool. It is generally assumed to be safe, although the consequences of its use can never be predicted with certainty.2 As our case highlights, use of OCPS may be associated with development of RCVS and awareness needs to be raised regarding this rare but serious complication.

    Original languageEnglish (US)
    Article number106006
    JournalJournal of Stroke and Cerebrovascular Diseases
    Volume30
    Issue number10
    DOIs
    StatePublished - Oct 2021

    Keywords

    • Oleoresin capsicum pepper spray (OCPS)
    • Reversible cerebral vasoconstriction syndrome (RCVS)
    • Thunderclap headaches
    • Vasospasm

    ASJC Scopus subject areas

    • Surgery
    • Rehabilitation
    • Clinical Neurology
    • Cardiology and Cardiovascular Medicine

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