Predictors of outcome in patients with presumed reversible cerebral vasoconstriction syndrome (RCVS)

INTRODUCTION: Reversible cerebral vasoconstriction syndrome (RCVS) is thought to be benign by nature, but a proportion of patients still suffer from neurological deficits on follow-up. OBJECTIVE: To understand what factors may influence a patient's recovery from RCVS. METHODS: The Clinical Research Data Warehouse at this institution was employed to search the medical records for patients with diagnosis and treatment of RCVS (2010-2021). After screening, 85 patients met inclusion criteria for a presumed diagnosis of RCVS with reported follow-up data. Patients were assessed by discharge modified Rankin Scale (mRS), which was grouped as lower (0 or 1) (n = 54) and higher (2 to 6) (n = 31). Clinical and radiographic data were analyzed. RESULTS: Median follow-up time was 80.0 (36.3-136) days for the lower discharge mRS group and 89.0 (39.0-179) days for the higher discharge mRS group. There were more females in the lower discharge mRS group (p = 0.027). Multivariate analysis selected sex (OR 0.220, 95% CI 0.068-0.709) and headache on presentation (OR 0.071, 95% CI 0.017-0.288) as predictive of lower discharge mRS, and a history hypertension (HTN) ([OR], 5.24 [95% CI, 1.65 - 16.7]), IPH on presentation ([OR], 8.21 [95% CI, 1.65 - 40.8]), and AMS on presentation ([OR], 25.8 [95% CI, 4.75 - 140]) as predictive of higher discharge mRS. CONCLUSION: Female sex and headache are associated with lower discharge mRS, while a history of HTN, IPH, and altered mental status are associated with higher discharge mRS. Future studies with larger sample size may help elucidate factors associated with poor neurological outcome.