Reversible cerebral vasoconstriction syndrome: not just a “reversible”condition. Retrospective observational study and literature review

This study aims to critically evaluate the evolving understanding of reversible cerebral vasoconstriction syndrome (RCVS) by examining its potential for long-term complications. While reversible cerebral vasoconstriction syndrome (RCVS) is traditionally recognised as a monophasic self-limiting condition, characterised by transient cerebral vasospasm, severe thunderclap headaches, and reversible cerebral vasoconstriction. However, recent evidence challenges this characterisation, revealing that the syndrome is neither universally self-limiting nor fully reversible. By analysing outcomes beyond the acute phase, this review seeks to redefine the prognostic spectrum of RCVS.

We conducted a retrospective review of RCVS cases over a 10-year period. A total of 97 cases were found, 28 cases were excluded due to change in diagnosis and a further 39 cases were also excluded as they did not fit the diagnostic criteria. The final patient cohort consisted of 30 patients.

Our review revealed a 27 % long term complication rate, including ischemic/haemorrhagic strokes (n = 3), persistent neurocognitive dysfunction (n = 2), chronic daily headaches (n = 1), and late-onset epilepsy (n = 2). Identified triggers included vasoactive agents, stress, and physical exertion. Nimodipine, which is commonly used as treatment, was associated with symptomatic relief but did not consistently prevent complications.

Our complication rate (27%) echoed the reported complication rates in the current literature (21%) for RCVS which challenge the traditional view and definition of RCVS as a self-limiting condition. The persistence of complications, including cognitive deficits and chronic pain, underscores the impact on patients’ quality of life and functional outcomes. Our review highlights the need for recognising clinical urgency, early diagnostic measures, and standardised treatment protocols. Further research is essential to explore the underlying pathophysiology, optimise therapeutic interventions, and evaluate the potential benefits of prompt treatment in reducing long-term complications and improving outcomes for patients with RCVS.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.