Reversible Cerebral Vasoconstriction Syndrome

Woman undergoing CT Scan
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Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by two main features. The first one is the sudden onset of a thunderclap headache. The second one is the presence of areas of narrowing or "vasoconstriction" where the wall of one or more arteries in the brain experience a cramp that prevents blood flow. These areas can be easily diagnosed by a catheter angiogram, although sometimes it can also be seen with magnetic resonance angiography (MRA).

Reversible cerebral vasoconstriction may or may not lead to a stroke. In many cases, stroke symptoms occur but are completely reversed later. However, some people may be left with permanent deficits. The event may also cause seizures and death.

What Is a Stroke? 

Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.

Stroke can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke). A TIA (transient ischemic attack), or "mini stroke", is caused by a temporary clot. 

RCVS can cause either ischemic or hemorrhagic strokes, typically in the form of a subarachnoid hemorrhage.

Risk Factors

  • Age — The chance of having a stroke approximately doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.
  • Heredity (family history) — Your stroke risk may be greater if a parent, grandparent, sister or brother has had a stroke.
  • Race — African-Americans have a much higher risk of death from a stroke than Caucasians do. This is partly because blacks have higher risks of high blood pressure, diabetes, and obesity.
  • Sex (gender) — Each year, women have more strokes than men, and stroke kills more women than men. Use of birth control pills, pregnancy, history of preeclampsia/eclampsia or gestational diabetes, oral contraceptive use, and smoking, and post-menopausal hormone therapy may pose special stroke risks for women. 
  • Prior stroke, TIA or heart attack — The risk of stroke for someone who has already had one is many times that of a person who has not. Transient ischemic attacks (TIAs) are "warning strokes" that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't. Recognizing and treating TIAs can reduce your risk of a major stroke. TIA should be considered a medical emergency and followed up immediately with a healthcare professional. If you've had a heart attack, you're at higher risk of having a stroke, too.

Who Is Affected by RCVS?

RCVS affects women more often than men, being most common after having given birth.


The cause of RCVS is not known, but it is thought that it results from a transient disturbance of the arterial wall, which leads to its constriction. Several substances have been associated with RCVS, including:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Nasal decongestants containing pseudoephedrine or ephedrine
  • Ergotamine
  • Tacrolimus
  • Nicotine patches
  • Cocaine
  • Marijuana
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  • Anne Ducros, Monique Boukobza, Raphaël Porcher, Mariana Sarov, Dominique Valade and Marie-Germaine Bousser; The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients: Brain 2007 130(12):3091-3101
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