emDocs - May 09, 2021 - By Tony Spadaro and Kevin R. Scott
Reviewed by: Richard Byyny; Alex Koyfman; Brit Long
“Conclusion
- Consider RCVS in patients with Thunderclap headache, particularly if they have had multiple episodes
- Physical exertion, triptans, and stimulants are common provoking causes of RCVS
- The diagnostic test of choice is CTA or MRA, which will classically show multiple segmental arterial narrowing; however, be aware that there can be a delay in imaging findings from symptom onset
- RCVS can be associated with focal ischemia, intracerebral hemorrhage, PRES, and cervical artery dissection
- Treatment includes calcium channel blockers such as nimodipine 30-60mg every 4 hours or a continuous infusion for severe cases. Avoid glucocorticoids, reverse anticoagulants if hemorrhage is present, and stop offending agents.”