E2194. Reversible Cerebral Vasoconstriction Syndrome: A Review of Diagnostic Imaging and Mimics
Authors
Gillean Cortes;
University of California, Irvine
Kenneth Huynh;
University of California, Irvine
Jennifer Soun;
University of California, Irvine
Background
Reversible cerebral vasoconstriction syndrome (RCVS) encompasses a group of clinical and radiological conditions characterized by acute onset recurrent thunderclap headaches and reversible cerebral angiopathy. The pathophysiology is largely unknown, nevertheless, research indicates several possible triggering factors and associated conditions such as stress, physical exertion, drugs or medications, and pregnancy. Neuroimaging may show multifocal narrowing and dilation of the cerebral arteries but often may be normal. Diagnosis remains difficult due to the wide range of differentials with similar clinical and imaging features. Outcomes are typically benign with supportive treatment; however, it is important to distinguish RCVS to exclude serious causes of morbidity and mortality such as primary central nervous system (CNS) vasculitis or aneurysmal subarachnoid hemorrhage to optimize management.
Educational Goals / Teaching Points
Review the epidemiology, clinical features, diagnostic work-up, prognosis, and management of RCVS. Describe key imaging characteristics of RCVS. Distinguish between several pathologies that may mimic RCVS through a case-based review highlighting clinical and imaging pearls.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will present a pictorial review of cases presented at our institution evaluating for anatomy and unique features on computed tomography (CT), CT angiography/magnetic resonance angiography, and conventional angiography. RCVS appears as multifocal segmental cerebral artery vasoconstriction and/or followed by abnormally dilated segments. Initial neuroimaging may be normal but can eventually develop vasogenic edema, hemorrhage, and infarcts among other complications. Lastly, several mimics of RCVS presentation will be compared including aneurysmal subarachnoid hemorrhage, primary CNS vasculitis, additional headaches and intracranial arteriopathies to further aid in distinguishing the diagnosis.
Conclusion
Despite the increasing knowledge of RCVS, various uncertainties still exist. RCVS continues to be a challenging diagnosis, especially with its overlapping set of clinical and imaging features. However, with the advent of new studies and neuroimaging, the radiologist can aid in providing more accurate and prompt diagnosis to aid in the management of more serious mimics.
