Hot chilli contest triggers cerebral vasoconstriction in US man

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A man developed “excruciating” thunderclap headaches as part of reversible cerebral vasoconstriction syndrome (RCVS) and had to get emergency medical attention after eating the world’s hottest chilli, the Carolina Reaper, as part of a hot pepper contest.

The Independent reports that doctors in New York reported the 34-year-old man came to the emergency department fearing a brain aneurysm after suffering multiple bouts of the skull-crushing headache. The headaches lasted several seconds and would strike out of the blue over a number of days. His other symptoms included intense neck pain and dry heaving.

After multiple tests doctors found no bulging or bleeding blood vessels that could be the sign of something more serious, and he had no slurred speech or issues with his vision. However, a CT scan of his blood flow showed severe constriction in the major arteries of his brain, which was diagnosed as the cause of his suffering.

The Carolina Reaper has held the title of hottest chilli since 2017, and averages 1.6m scoville heat units (SHU). Academics at Winthrop University in South Carolina recorded some peppers as hot as 2.2m SHUs. The bhut jolokia, or ghost pepper, is commonly thought of as the world’s hottest chilli but it averages only around a million SHUs, while a jalapeno chilli pepper is no more than 8,000 SHUs.

The doctors diagnosed the “unusual” cause of reversible cerebral vasoconstriction syndrome (RCVS) accompanied by “thunderclap headaches” and said it should be considered by other medics after more serious causes are ruled out.

The treatment recommendation was to remove any remaining chilli and keep the patient – who has not been named – under observation. After five weeks the blood vessels had returned to normal.

The report says this is the first time a chilli has been described as causing this brain blood vessel constriction, though it can occur in response to certain medications, including some antidepressants, as well as illicit drugs like cocaine and ecstasy. Eating intense cayenne pepper has previously been identified as a cause of “vasospasm”, where the blood vessels constrict in other parts of the body, and has caused heart attacks.

The authors write: “Given the development of symptoms immediately after exposure to a known vasoactive substance, it is plausible that our patient had RCVS secondary to the ‘Carolina Reaper’. Treatment is observation and removal of the offending agent.”

The heat-causing chemical capsaicin in chillis is produced by plants to deter pests.Through selective breeding, nutrition, and  growing plants under high stress conditions that mimic constant attack, farmers are able to significantly increase its concentration in the plant.

A 34-year-old man with no significant medical history presented to the emergency room (ER) after an episode of thunderclap headache. His symptoms began with dry heaves but no vomiting immediately after participation in a hot pepper contest where he ate one ‘Carolina Reaper,’ the hottest chili pepper in the world. He then developed intense neck and occipital head pain that became holocephalic. During the next few days, on at least two occasions and in retrospect he thought probably more often, he experienced brief intense thunderclap headaches lasting seconds. The pain was excruciating and thus he came to the ER. He denied any focal tingling sensation or weakness, slurred speech, or transient loss of vision. Physical examination revealed blood pressure of 134/69 mm Hg and …

Satish Kumar Boddhula, Sowmya Boddhula, Kulothungan Gunasekaran, Edward Bischof

The Independent report
BMJ Case Reports abstract

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