RCVS: by clinicians for clinicians-a narrative review

Area of Science:

• Neurology
• Vascular Neurology
• Neurocritical Care

Background:

• Reversible cerebral vasoconstriction syndrome (RCVS) is a clinical-radiological condition that may be underdiagnosed.
• RCVS can lead to severe complications, including intracerebral hemorrhage and ischemic stroke.
• Clinical presentation varies based on the affected brain regions.

Purpose of the Study:

• To increase awareness of RCVS, particularly in patients with known risk factors.
• To elucidate the precipitating factors, pathophysiology, and complications of RCVS.
• To compare RCVS with its differential diagnoses.

Main Methods:

• A comprehensive literature review was performed using PubMed/MEDLINE and Google Scholar.
• The search encompassed publications from May 1997 to May 2022.

Main Results:

• RCVS is characterized by thunderclap headache and widespread cerebral vasoconstriction.
• Common triggers include vasoactive substance use and postpartum status.
• Pathophysiology involves sympathetic overactivity and endothelial dysfunction, leading to complications and differential diagnoses like PRES, SAH, and stroke.

Conclusions:

• RCVS generally has a favorable prognosis.
• Vasospasm and thunderclap headaches are typically reversible.
• Over 90% of patients achieve functional independence upon discharge.