SHM Converge Scientific Abstract ePoster Gallery-When Is a Migraine More? Reversible Cerebral Vasoconstrictive Syndrome, an Underdiagnosis in Women

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This case report describes reversible cerebral vasoconstriction syndrome (RCVS), a frequently underrecognized cause of acute neurologic symptoms, especially in women. RCVS is marked by sudden severe headaches, often thunderclap-type, and may also cause seizures, focal deficits, hemorrhage, or stroke.<br /><br />The patient was a 40-year-old woman with hypertension and migraine history, including recent episodes of very sudden, severe headaches and one prior hemiplegic migraine. She came to the emergency department with right-sided weakness and facial droop. Initial CT suggested ischemic changes, and she received tPA. CT angiography later showed diffuse vascular irregularities in multiple brain territories, but MRI did not confirm acute ischemia. Her echocardiogram was normal, and she initially improved, but two days later her weakness worsened and she developed a sudden headache.<br /><br />Because repeat imaging did not explain her symptoms, she underwent a diagnostic cerebral angiogram, which confirmed RCVS. Intra-arterial verapamil led to both clinical and radiographic improvement. Vasoconstrictive or potentially aggravating medications, including serotonin-modulating drugs, triptans, and NSAIDs, were stopped.<br /><br />The report emphasizes that women with acute transient neurologic symptoms are more likely to be misdiagnosed than men, creating missed opportunities for treatment and prevention. It also highlights that RCVS can resemble migraine or stroke, but requires different management. Early recognition is important because RCVS can lead to serious complications such as infarction, hemorrhage, and seizures.

Asset Subtitle

Armita Kadivar

Meta Tag

Author List Armita Kadivar, Jaclyn Vargas, Jonathan Dounel, Priya Sharma

Category Clinical Vignettes

Concept Reversible Cerebral Vasoconstriction Syndrome

Concept Thunderclap Headache

Concept Focal Neurologic Deficit

Concept Angiography

Concept Vasoactive Agent

Distinguished Non-Finalist

Presenter Organization Ucsd Som

Presenting Author Armita Kadivar

Track Adult

Keywords

reversible cerebral vasoconstriction syndrome

RCVS

thunderclap headache

acute neurologic symptoms

women

stroke mimic

cerebral angiogram

intra-arterial verapamil

vasoconstriction

migraine

Reversible Cerebral Vasoconstriction Syndrome

Thunderclap Headache

Focal Neurologic Deficit

Angiography

Vasoactive Agent