Biopsy Avoids Overdiagnosis of CNS Vasculitis

RCVS consists of a group of diverse conditions that are characterized by reversible multifocal narrowing of the cerebral arteries. The first symptom of RCVS is sudden (thunderclap), severe headaches with or without associated neurologic deficits. Drugs, such as phenylpropanolamine, pseudoephedrine, and others, are frequently behind RCVS.

RCVS and PACNS do have some distinguishing features. RCVS is more common among women, while PACNS is more common among men. RCVS is marked by a thunderclap-type headache, whereas PACNS is more insidious. Patients with RCVS have floridly positive angiograms.

Current suggestions for the treatment of RCVS include observation for mild cases, calcium channel blockers (nimodipine, verapamil), or high-dose steroids.