Reversible cerebral vasoconstriction syndrome: a comprehensive systematic review

Area of Science:

• Neurology
• Neuroscience
• Vascular Neurology

Background:

• Reversible cerebral vasoconstriction syndrome (RCVS) is a condition characterized by temporary narrowing of brain arteries.
• Understanding its triggers, clinical course, and outcomes is crucial for patient management.

Purpose of the Study:

• To analyze the clinical characteristics, treatment patterns, and prognosis of patients diagnosed with RCVS.
• To identify risk factors associated with residual neurological deficits after RCVS.

Main Methods:

• A systematic review of PubMed and EMBASE databases was conducted.
• 191 cases of RCVS were included, with data collected on demographics, triggers, imaging, treatments, recurrence, and outcomes.
• Multivariate analysis was used to identify independent risk factors for neurological deficits.

Main Results:

• The study included 191 patients, predominantly female (81.2%), with a mean age of 39.9 years.
• Vasoactive substances (41.4%) were the most common trigger, followed by pregnancy/postpartum (20.9%).
• Multifocal stenosis (84.0%) and beading (82.4%) were common angiographic findings. Trauma/surgery (HR: 3.29) and focal neurological deficits (HR: 3.83) independently predicted worse outcomes.

Conclusions:

• Vasoactive substances are frequent triggers for RCVS, often associated with multifocal stenotic lesions on angiography.
• Patients experiencing RCVS due to trauma/surgery or presenting with focal cortical deficits face a higher risk of long-term neurological deficits.
• Close monitoring is recommended for high-risk RCVS patients to mitigate potential residual neurological deficits.