Abstract Details

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent episodes of severe headache associated with reversible, diffuse, segmental vasoconstriction of the cerebral arteries. Cortical surface subarachnoid hemorrhage (cSAH) could be an imaging finding of the disease. In addition, intracerebral hemorrhage (ICH) and ischemic strokes may occur in a minority of patients. Evidence regarding clinical outcomes is controversial between studies.

Analyze demographic and clinical characteristics and identify predictors of cortical surface subarachnoid hemorrhage in reversible cerebral vasoconstriction syndrome

Retrospective analysis of medical records patients with RCVS admitted between January/2012 and July/2021. Demographic, clinical and radiological characteristics were analyzed. Patients with evidence of vasoconstriction in CT, MRI and/or intracranial digital angiography were included. Fisher's exact test was used for categorical variables and Wilcoxon for continuous variables.

51 patients were included (69% women, 44 ± 12 years), 20 with cHSA and 31 without cHSA. Of all patients 59% identified a trigger, the most frequent being sexual activity and use of vasoactive drugs (37% both cases). 80% presented with thunderclap headache, being recurrent in 93% of the cases. 24% had focal neurological deficit and 12% had epileptic seizures. Vascular risk factors were present in 49% of patients, the most frequent being dyslipidemia (29%). The most affected vascular territory was that of the middle cerebral artery (82%). cHSA was detected in 39% of cases, ischemic stroke in 6%, and ICH in 2%. The presence of cHSA was not associated with increased morbidity and mortality. Median age was higher in the group that developed cSAH (53 vs 41; p=0.003), with the probability of risk of cSAH increasing with age (OR: 1.2).

The demographic and clinical characteristics of our population were similar to those described in the literature. 4 out of 10 patients with RCVS had cSAH, which was not associated with greater severity of the condition.