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Reversible Cerebral Vasoconstriction Syndrome.

Kenneth R L Bernard1, Morris Rivera2

  • 1Harvard Affiliated Emergency Medicine Program, Department of Emergency Medicine, Brigham and Womens/Massachusetts General Hospital, Boston, Massachusetts.

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|April 11, 2015
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Summary
This summary is machine-generated.

Reversible cerebral vasoconstriction syndrome (RCVS) is an underappreciated cause of thunderclap headache (TCH). Increased awareness is crucial for emergency physicians to avoid misdiagnosis and ensure appropriate patient management.

Keywords:
headachereversible cerebrovasconstriction syndromesubarachnoid hemorrhagethunderclap

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Area of Science:

  • Neurology
  • Emergency Medicine

Background:

  • Reversible cerebral vasoconstriction syndrome (RCVS) is an underdiagnosed cause of thunderclap headache (TCH).
  • RCVS shares overlapping symptoms with serious conditions like subarachnoid hemorrhage and stroke, leading to potential misdiagnosis.
  • Misdiagnosis can result in unnecessary invasive procedures or harmful treatments, as glucocorticoids for primary angiitis of the central nervous system (PACNS) can worsen RCVS.

Observation:

  • A previously healthy male presented with recurrent TCH and angiography confirmed RCVS.
  • The case highlights the diagnostic challenges in the emergency department setting.

Findings:

  • RCVS is a common yet underappreciated cause of TCH.
  • High likelihood of misdiagnosis exists due to lack of awareness and overlapping features with other headache syndromes.
  • Emergency physicians must consider RCVS in the differential diagnosis of TCH.

Implications:

  • Broadening the differential diagnosis for TCH is essential for emergency physicians.
  • Familiarity with RCVS treatments and follow-up protocols is necessary.
  • Accurate identification of RCVS is needed for prospective studies to validate treatments and prognoses.