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Outcomes After Reversible Cerebral Vasoconstriction Syndrome With Convexity Subarachnoid Hemorrhage: Individual
Isabel Charlotte Hostettler1,2,3, Ana Ponciano1, Duncan Wilson1
1Stroke Research Centre, University College London, Institute of Neurology, United Kingdom.
Neurology
|August 20, 2025
Summary
Patients with convexity subarachnoid hemorrhage (cSAH) due to reversible cerebral vasoconstriction syndrome (RCVS) have a good prognosis. Most patients achieve functional independence with low rates of recurrent vascular events like cSAH, ICH, or ischemic stroke.
Area of Science:
- Neurology
- Vascular Neurology
- Neurocritical Care
Background:
- Convexity subarachnoid hemorrhage (cSAH) in younger patients is often caused by reversible cerebral vasoconstriction syndrome (RCVS).
- Limited data exist on long-term outcomes and functional recovery after RCVS-associated cSAH.
Purpose of the Study:
- To assess the rates of recurrent cSAH, intracerebral hemorrhage (ICH), and ischemic stroke after RCVS-associated cSAH.
- To evaluate functional outcomes and mortality in these patients.
- To identify baseline predictors for these outcomes.
Main Methods:
- Individual patient data from a pooled analysis of 21 eligible cohorts (138 patients) were used.
- Systematic literature search conducted in PubMed and EMBASE.
- Follow-up was truncated at 5 years, with outcomes including recurrent cSAH, ICH, ischemic stroke, mortality, and modified Rankin Score (mRS).
Main Results:
- During a mean follow-up of 1.8 years, annual recurrence rates for cSAH, ICH, and ischemic stroke were all 0.81%.
- Most patients (94.3%) achieved a modified Rankin Score of ≤1, indicating minimal to no disability.
- Two deaths occurred (annual rate 0.5%), both within two months of the initial cSAH event.
Conclusions:
- RCVS-associated cSAH generally has a favorable prognosis with low rates of recurrent vascular events.
- A high proportion of patients achieve functional independence.
- Findings provide valuable prognostic information for clinical practice, despite limitations of retrospective data collection and potential selection bias.
