Chapter 7.1 - Reversible Cerebral Vasoconstriction Syndrome

Summary

RCVS is a clinical radiological syndrome that typically presents with severe headache, with or without other neurological symptoms, and is associated with diffuse multifocal cerebral vasoconstriction that resolves spontaneously within 3 months. Most of the RCVS cases are associated with vasoactive medications, recreational drugs, pregnancy and postpartum state and migraine headaches.It usually begins with an acute, extremely severe thunderclap headache, like a headache in subarachnoid hemorrhage. Epileptic seizures have been reported and focal neurological deficit may present as a TIA or with visual disturbances. In more than 90% of patients, complete withdrawal of symptoms occur, but RCVS may be complicated with cerebral infarction, intracerebral hemorrhage, subarachnoid hemorrhage, or posterior reversible encephalopathy syndrome.Rarely, these complications lead to death. Catheter angiography, MR angiography or CT angiography may disclose a “string-of-beads” and “sausage and strings” appearance of vessels. In the treatment of cerebral vasospasm, the use of calcium channel blockers for about 4-8 weeks may be considered