October 10, 2013: Reversible Cerebral Vasoconstriction Syndrome

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October 10, 2013

Thunderclap headache is characterized by a sudden onset of severe pain which reaches peak intensity within a minute. It is often associated with subarachnoid hemorrhage, but can be observed in other neurologic processes including cerebral venous thrombosis, cervical artery dissection, and reversible cerebral vasoconstriction syndrome (RCVS).  In RCVS, the thunderclap headache will last minutes to hours and is often recurrent and diffuse in quality. Precipitants of RCVS are varied and include exposure to vasoactive drugs, the post-partum state posterior reversible encephalopathy syndrome, and cervical and cerebral artery lesions.  Workup of patients with suspected RCVS will include intracranial vascular imaging hallmarked by diffuse segmental narrowing and dilation.


1. Schwedt TJ, Matharu MS, Dodick DW. Thunderclap headache. Lancet Neurology 2006; 5: 621-631.

2. Ducros A, Boukobza M, Porcher R, et al. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome: a prospective series of 67 patients. Brain 2007; 130: 3091-3101.

Submitted by Adam Numis, M.D. Resident Physician, University of California, San Francisco

Disclosures: Dr. Numis is a member of the Resident and Fellow Section of Neurology.

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