Reversible Cerebral Vasoconstriction Syndromes (RCVS)

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Cerebral Arteriopathies 1. Large or Medium-Sized Arteries a. Atherosclerosis b. Cerebral artery dissection c. Reversible cerebral vasoconstriction syndromes d. Genetic or Inherited: Moyamoya, Sickle, Fabry’s, FMD e. Inflammatory: Takayasu, Anti-phospholipid antibody-associated f. Infectious: TB, Herpes zoster, syphilis, bacterial, HIV 2. Small Vessel Disease a. Inflammatory: PACNS, Giant-cell, Amyloid, PAN, SLE, Behcet’s, Scleroderma, Churg-Strauss, Degos’, Eale’s, Susac, Spatz-Lindenbergh b. Infectious: Herpes zoster, Cysticercosis c. Genetic or Inherited: CADASIL, HERNS, COL4A1 mutation
Illustrative Case 46 year male: acute, 10/10 post coital headache CT-A : MCA, PCA, SCA, PICA, basilar ‘beading’ Vasculitis labs negative, CSF normal (no SAH, 0 WBC)
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Reversible Cerebral Vasoconstrictio
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Patients (mostly women): rTCH ± st
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Key Elements for Diagnosis 1. Sever
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Characteristic Clinical Features CC
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Laboratory and Imaging Features Cha
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Characteristic Follow-up Imaging CC
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RCVS: Brain Imaging
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Brain Hemorrhage in RCVS Hemorrhage
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• Migraine Differential Diagnosis
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Diagnostic Approach 1. Clinical Rec
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Characteristic Treatment and Outcom
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CTA before IA treatment (PPD 20) Si
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Final MRI 6 Days After Admission Si
Page 28 and 29: RCVS • Group of conditions charac
Page 31 and 32: Stroke attributed to ‘vasospasm
Page 36 and 37: Hemorrhages in 1 st week, Infarcts
Page 38 and 39: Pathophysiology
Page 40 and 41: A B C (A) Headframe used for bedsid
Page 42 and 43: Perivascular nerves smooth muscle c
Page 44 and 45: Endothelium • Modulates vascular
Page 46 and 47: Spectrum - disorders of cerebrovasc
Page 48 and 49: RCVS and Drugs/Meds Ergot derivativ
Page 50 and 51: Serotonin - central role in RCVS? S
Page 52 and 53: Serotonergic meds common…but RCVS
Page 54 and 55: RCVS and Migraine Is RCVS simply a
Page 56 and 57: Neurology 2006: 67:2164 • Prospec
Page 58 and 59: RCVS-SAH (n=35) vs. aSAH (n=515)
Page 60 and 61: RCVS vs. PACNS
Page 63 and 64: Angio positive in 70 cases; biopsy
Page 65 and 66: RCVS vs PACNS: MGH cases, 1993-2009
Page 67 and 68: RCVS vs PACNS: MGH cases, 1993-2009
Page 69 and 70: Brain lesion topography in RCVS 3.
Page 71 and 72: Lesion patterns in PACNS 2. Diffuse
Page 73 and 74: Distinguishing RCVS from PACNS Clin
Page 75 and 76: Advanced MRI for Cerebral Arteriopa
Page 77: To study the phenomena of disease w
Page 81 and 82: Illustrative Case MR angio - severe
Page 84 and 85: PACNS - Typical Angiographic featur
Page 86: Treatment vs Poor Outcome All Patie
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Reversible Cerebral Vasoconstriction Syndromes (RCVS)

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