Possible Triggers of RCVS
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
Differentials of Thunderclap headache and stroke
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.
References and further reading
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Reversible cerebral vasoconstriction syndrome
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