Reversible cerebral vasoconstriction syndrome: A narrative review

Area of Science:

• Neurology
• Cerebrovascular Diseases
• Neuroimaging

Background:

• Reversible cerebral vasoconstriction syndrome (RCVS) presents with recurrent thunderclap headaches and transient cerebral artery vasoconstriction.
• The condition typically resolves within three months but can lead to severe complications like stroke and cerebral edema.

Purpose of the Study:

• To review current knowledge on the diagnosis, management, and outcomes of RCVS.
• To highlight the importance of differentiating RCVS from other neurological conditions with overlapping symptoms.

Main Methods:

• A comprehensive literature search was conducted across major databases: MEDLINE (PubMed), Embase, Scopus, and Cochrane Library.
• Review of existing studies on RCVS diagnosis, triggers, complications, and treatment.

Main Results:

• RCVS triggers include vasoactive substances, pregnancy, postpartum state, and stress.
• Advanced neuroimaging techniques like MRA and vessel wall imaging improve diagnostic accuracy.
• Management involves trigger avoidance and symptomatic support; calcium channel blockers are commonly used with uncertain efficacy.

Conclusions:

• Most patients with RCVS recover, but chronic symptoms like headaches and cognitive impairment indicate a need for long-term follow-up.
• The concept of a "post-RCVS syndrome" is suggested by persistent neurological deficits.
• Accurate diagnosis is crucial due to differing treatments compared to conditions with similar presentations.