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|Fisher first described the phenomenon of reversible segmental cerebral vasoconstriction in the early 1970s, in a paper reporting cases of postpartum women with transient neurologic dysfunction associated with reversible cerebral arterial irregularities and the entity became known as "postpartum angiopathy"
|Criteria for RCVS [Calabrese et al. 2007]
|Acute and severe headache (often thunderclap headache) with or without focal neurological deficits or seizures
|Monophasic course without new symptoms more than 1 month after clinical onset
|Segmental vasoconstriction of cerebral arteries demonstrated by angiography (MRA, CTA or catheter)
|Exclusion of subarachnoid haemorrhage due to a ruptured aneurysm
|Normal or near normal CSF (protein <1g/l, white cells < 15/mm3, normal glucose)
|Complete or marked normalisation of arteries demonstrated by a repeat angiogram (MRA, CTA or catheter) after 12 weeks, although they may be normal earlier
|Note the subtle sulcal blood which can be very easy to miss. This can cause focal seizure and weakness and is a stroke mimic. I have seen subtle bleeding like this missed by experts and patient thrombolysed with disastrous outcome.