Clinical features

clinical features

The condition is usually acute and self-limiting without new symptoms after 1 month. RCVS may present as thunderclap headache (TCH) in isolation or TCH with associated neurologic symptoms (1).

Headaches remain the main and often the only manifestation in these patients

• presents with acute headaches - thunderclap headaches
• pain may last for few minutes to few hours
• typically bilateral (but can be unilateral) with posterior onset followed by diffuse pain
• screaming, crying, agitation, confusion and collapse are common due to the severity of the pain
• nausea, vomiting, photophobia, and phonophobia is seen frequently
• multiple episodes of thunderclap headaches are seen which recur every day or so for a few days to four weeks (but a single attack is also possible)
• between exacerbations the patient may complain of a persistent moderate headache (1,2)

In about third of patients, a surge in blood pressure can be observed during acute headaches (2)

Other associated symptoms include:

• neck pain - think of cervical artery dissection
• focal deficits
  • transient -
    • occurs in slightly more than 10% of patients
    • last from 1 min to 4 h
    • frequently visual, but sensory, dysphasic, or motor deficits can also occur
  • persistent seizures

Reference:

• (1) Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol. 2012;11(10):906-17
• (2) Ducros A, Bousser MG. Thunderclap headache. BMJ. 2013;346:e8557