Reversible Cerebral Vasoconstriction Syndrome – A Systematic Approach

Aims: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare idiopathic clinical syndrome presenting as reversible multifocal segmental vasoconstriction of cerebral arteries, typically affecting middle aged women. A 52 year old lady with radiological features of RCVS is presented.

Presentation of Case: A 52 year old lady presented with recurrent thunderclap headache. Initial laboratory and radiological investigations were normal. Over the course of two weeks she developed stroke like symptoms with haemorrhagic transformation. Serial imaging revealed development and resolution of cerebral arterial stricture.

Discussion: RCVS is often an under-diagnosed entity in patients with thunderclap headache. The initial MRI may be normal but the repeat MRI after two to three weeks may show features of stroke with associated vascular abnormalities. The follow up of these cases with radiological investigations may help in precise diagnosis.

Conclusion: Differentiating RCVS from other causes of thunderclap headache can significantly alter the management options and further prognosis.