Reversible cerebral vasoconstriction syndrome with reversible renal artery stenosis

A 41-year-old woman presented with thunderclap headaches, cortical blindness, generalized seizures, and severe hypertension. Brain imaging (figure) showed features of reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome.1 Her neurologic examination improved, but severe hypertension persisted. Abdomen CT angiography showed right renal artery narrowing with possible dissection, initially attributed to fibromuscular dysplasia (FMD). Renal angioplasty was considered; however, she was discharged on multiple antihypertensive agents. Her blood pressure normalized, and parenchymal lesions and vertebral/renal artery abnormalities showed complete resolution on follow-up at 7 months. This case emphasizes that RCVS can affect the extracerebral systemic arteries,2 and can be misinterpreted as FMD.