Reversible Cerebral Vasoconstriction Syndrome: A Review of Key Radiologic and Clinical Features for Timely Diagnosis

SUMMARY: Reversible cerebral vasoconstriction syndrome (RCVS) is a clinical-radiologic entity characterized by a “thunderclap” headache and reversible narrowing of the intracranial arteries. Complications of RCVS include intracranial hemorrhage, ischemic stroke, and cerebral edema. RCVS can occur spontaneously but has known associations with the peripartum state, preeclampsia, and exposure to vasoactive drugs and pharmaceuticals. There is a clinical and radiologic overlap of RCVS with CNS vasculitis, vasospasm, and atherosclerotic disease. In general, RCVS is more commonly associated with acute onset of a powerful headache with radiologic features of concentric medium-to-large vessel luminal narrowing in multiple territories. MRA vessel wall imaging in RCVS is variable but was historically associated with a pattern of concentric wall thickening to impacted vessels with little-to-no mural enhancement. Radiographic findings are expected to resolve 1−3 months after onset. Differentiating between intracranial arteriopathies is important because inappropriate treatment has been associated with worse outcomes; an understanding of the characteristic clinical and imaging features can aid in a timely and appropriate diagnosis.