Vessel wall imaging for diagnosis and follow-up of basilar artery reversible cerebral vasoconstriction syndrome (RCVS)

Abstract

Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a clinical and radiological syndrome that is primarily defined by thunderclap headache, with or without further neurological deficits, and segmental intracranial vasoconstriction that resolves within three months. The current nomenclature was only established in 2007, but it has been known with diferent names for over fifty years. The pathophysiology, while still not completely understood, seems to point towards a disease based on abnormalities of vascular tonus without structural inflammation. It is clear, however, that patients with RCVS often have triggers, especially drugs or other vasoactive substances. Distinguishing this entity from others, especially subarachnoid hemorrhage and arterial
dissection, is extremely important, given the particular prognosis and need of immediate treatment of each disease. The preferred imaging method has long been the angiography; however, new magnetic resonance imaging (MRI) such as vessel wall imaging have allowed for non-invasive
diagnosis and follow-up. The authors report a case in which MRI was used in a patient with basilar artery RCVS and present a literature review.