Reversible cerebral vasoconstriction syndrome: A narrative review

OBJECTIVES/BACKGROUND: This review summarizes current insights into Reversible cerebral vasoconstriction syndrome (RCVS) diagnosis, management, and outcomes. RCVS is a cerebrovascular disorder characterized by recurrent thunderclap headaches and transient segmental vasoconstriction of cerebral arteries, typically resolving within 3 months. METHODS: A comprehensive database search was performed across MEDLINE (via PubMed), Embase, Scopus, and the Cochrane Library. RESULTS: Although often self-limiting, RCVS may cause complications such as subarachnoid hemorrhage, ischemic stroke, and cerebral edema. Triggers include vasoactive substances, pregnancy, postpartum state, and physical or emotional stress. Differentiating RCVS from conditions like primary angiitis of the central nervous system, aneurysmal subarachnoid hemorrhage, and cerebral venous thrombosis is essential because clinical and imaging features may overlap, whereas treatments differ. Advances in neuroimaging, especially magnetic resonance angiography and vessel wall imaging, have enhanced diagnostic accuracy. Management focuses on eliminating triggers and symptomatic support. Calcium channel blockers are frequently used, although their impact on disease evolution remains uncertain. CONCLUSION: Although most patients recover without major sequelae, chronic symptoms such as long-term headaches and neuropsychological symptoms, including cognitive impairment, underscore the need for ongoing follow-up and suggest a post-RCVS syndrome.