RCVS

Q: Seizure is more common with? (select one)

A) Reversible cerebral vasoconstriction syndrome (RCVS) 

B) Reversible posterior leukoencephalopathy syndrome (RPLS)

Answer: A

RCVS, like RPLS is also due to dysregulation of cerebral arterial tone. A major differentiating feature is the quality of headaches. In RCVS, headaches are classically sudden in contrast to insidious in RPLS. Visual symptoms, seizures, and MRI abnormalities are less common with RCVS. To make things confusing, both can occur together.

RCVS is actually an umbrella term for various etiologies. It is usually due to reversible multifocal narrowing of the cerebral arteries and presents as thunderclap-like headache. It may also manifest as a focal neurologic. It is mostly benign. 

The other names are migrainous vasospasm, migraine angiitis, Call-Fleming syndrome, Call syndrome, thunderclap headache-associated vasospasm, drug-induced cerebral arteritis, postpartum cerebral angiopathy, benign angiopathy of the central nervous system, and central nervous system pseudovasculitis.

#neurology

References:

1. Jun-O'Connell AH, Sundar B, Morris M. The Spectrum of Cerebral Vasoconstriction: A Diagnostic Conundrum. J Neurol Stroke 2016; 4:00119.

2. Singhal AB, Hajj-Ali RA, Topcuoglu MA, et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 2011; 68:1005.