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RCVS — Reversible Cerebral Vasoconstriction Syndrome

Recurrent thunderclap headaches with reversible multifocal cerebral artery narrowing.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is RCVS — Reversible Cerebral Vasoconstriction Syndrome?

Reversible cerebral vasoconstriction syndrome (RCVS, Call-Fleming syndrome) is a transient disturbance of cerebral arterial tone with characteristic 'string-of-beads' segmental narrowing of medium and large cerebral arteries that resolves spontaneously within 1-3 months.

Typical presentation is recurrent thunderclap headache (peak intensity within seconds), with or without focal neurological deficit, seizure or convexity subarachnoid haemorrhage; differential diagnosis includes primary CNS angiitis, aneurysmal SAH and cervical artery dissection.

Triggers include sympathomimetic agents (cocaine, amphetamines, pseudoephedrine), serotonergic drugs (SSRIs, triptans), postpartum state, eclampsia and immunosuppressants; diagnosis is by characteristic angiography and a normal cerebrospinal fluid profile, with confirmation by resolution at follow-up imaging.

Symptoms

Recurrent thunderclap headache
Headache triggered by exertion, Valsalva or sex
Focal neurological deficit
Generalised or focal seizure
Convexity subarachnoid haemorrhage
Posterior reversible encephalopathy syndrome (PRES) overlap
Visual disturbance and confusion

Risk Factors

Use of cocaine, amphetamines, ecstasy
SSRI, SNRI and triptan therapy
Postpartum state and eclampsia
Pseudoephedrine and decongestant use
Cannabis and nicotine
Calcineurin inhibitors and immunosuppressants
Catecholamine-secreting tumours

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden severe thunderclap headache
  • Recurrent thunderclap headaches
  • New focal neurological deficit
  • Headache with seizure or visual loss

Treatment Methods

01
CT/CTA to exclude aneurysmal SAH
02
MRI/MRA showing string-of-beads narrowing
03
Lumbar puncture (normal in RCVS)
04
Discontinue precipitating vasoactive drugs
05
Calcium channel blockers (nimodipine, verapamil)
06
Blood pressure control and avoidance of triggers
07
Follow-up vessel imaging at 6-12 weeks for resolution

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.