Reversible Cerebral Vasoconstriction Syndrome: A Review of Diagnostic Imaging and Mimics

Reversible cerebral vasoconstriction syndrome (RCVS) encompasses a group of clinical and radiological conditions characterized by acute onset recurrent thunderclap headaches and reversible cerebral angiopathy. The pathophysiology is largely unknown, nevertheless, research indicates several possible triggering factors and associated conditions such as stress, physical exertion, drugs or medications, and pregnancy. Neuroimaging may show multifocal narrowing and dilation of the cerebral arteries but often may be normal. Diagnosis remains difficult due to the wide range of differentials with similar clinical and imaging features. Outcomes are typically benign with supportive treatment; however, it is important for the radiologist to distinguish RCVS from other entities to exclude serious causes of morbidity and mortality to optimize management.