Reversible cerebral vasoconstriction syndrome, AKA RCVS, refers to a group of diseases with similar clinical presentations and imaging features. As indicated by the name itself, typical findings on DSA would show multifocal segmental cerebral artery vasoconstriction. RCVS2 score could be used to help with diagnosis.
This patient presented with typical thunderclap headaches without any other complaints or deficits. CT head showed a possible left caudate head IPH without mass effect or surrounding edema. CTA head was unremarkable. The CSF study was largely within normal limits. The patient subsequently underwent diagnostic cerebral angiography, which showed multifocal segmental stenoses (red arrows), consistent with RCVS. Also, note the proximal right A3 contrast filling defect (yellow arrow), concerning for dissection vs. thrombus.
3D Reconstruction - Right ICA Injection
(A): The multifocal segmental stenoses (white arrows) can also be clearly seen on the 3D reconstruction imaging. (B): The suspected right A3 dissection vs. thrombus turned out to be duplicate ACAs. Please also note the right PCOM infundibulum (blue arrow).