Summary of critical elements for the diagnosis of reversible cerebral vasoconstriction syndromes (RCVS)

1. Single or (most often) recurrent thunderclap headaches.

2. Multifocal segmental cerebral artery vasoconstriction demonstrated on cerebral angiography (with CTA, MRA, or DSA) that usually develops within a week of symptom onset.

3. No evidence for aneurysmal SAH.

4. Brain imaging findings are often normal, or may show vasogenic edema (PRES) and/or FLAIR sulcal hyperintensities (dot sign). Infarcts, if present, are usually symmetric and distributed along border zones of arterial territories. Intraparenchymal hemorrhage and/or nonaneurysmal convexity SAH may be present in some cases of RCVS.

RCVS: reversible cerebral vasoconstriction syndromes; CTA: computed tomography angiography; MRA: magnetic resonance angiography; DSA: digital subtraction angiography; FLAIR: fluid-attenuated inversion recovery; PRES: posterior reversible encephalopathy syndrome; SAH: subarachnoid hemorrhage.

Modified from Annals of Internal Medicine, Calabrese LH, Dodick DW, Schwedt TJ, et al. Narrative review: Reversible cerebral vasoconstriction syndromes, Volume 146, Issue 1, Pages 34-44. Copyright © 2007 American College of Physicians. All Rights Reserved. Reprinted with the permission of American College of Physicians, Inc.

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Summary of critical elements for the diagnosis of reversible cerebral vasoconstriction syndromes (RCVS)