The reversible cerebral vasoconstriction syndrome should be considered in an adult with a history of recurrent headaches.


The typical patient is a woman from 20 to 60 years of age.


Clinical findings:

(1) recurrent severe headaches, which may be classified as "thunderclap" or migraine

(2) may be associated with a risk factor (see previous section) but also may be idiopathic

(3) attacks often associated with nausea, vomiting and photophobia

(4) fluctuating or recurring sensory and/or motor deficits with or without seizures

(5) neurologic consequences often are reversible but some patients may develop permanent neurologic disabilities


Imaging findings:

(1) reversible segmental arterial vasoconstriction (vasospasm) on CT angiography or other imaging study


Histologic findings:

(1) no evidence of vasculitis


Therapy usually involves therapy with:

(1) corticosteroids

(2) calcium channel antagonists

(3) control of blood pressure


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