Predictors of outcome in patients with presumed reversible cerebral vasoconstriction syndrome (RCVS)

Introduction

Reversible cerebral vasoconstriction syndrome (RCVS) is thought to be benign by nature, but a proportion of patients still suffer from neurological deficits on follow-up.

Objective

To understand what factors may influence a patient's recovery from RCVS.

Methods

The Clinical Research Data Warehouse at this institution was employed to search the medical records for patients with diagnosis and treatment of RCVS (2010–2021). After screening, 85 patients met inclusion criteria for a presumed diagnosis of RCVS with reported follow-up data. Patients were assessed by discharge modified Rankin Scale (mRS), which was grouped as lower (0 or 1) (n = 54) and higher (2 to 6) (n = 31). Clinical and radiographic data were analyzed.

Results

Median follow-up time was 80.0 (36.3–136) days for the lower discharge mRS group and 89.0 (39.0–179) days for the higher discharge mRS group. There were more females in the lower discharge mRS group (p = 0.027). Multivariate analysis selected sex (OR 0.220, 95% CI 0.068–0.709) and headache on presentation (OR 0.071, 95% CI 0.017–0.288) as predictive of lower discharge mRS, and a history hypertension (HTN) ([OR], 5.24 [95% CI, 1.65 - 16.7]), IPH on presentation ([OR], 8.21 [95% CI, 1.65 - 40.8]), and AMS on presentation ([OR], 25.8 [95% CI, 4.75 - 140]) as predictive of higher discharge mRS.

Conclusion

Female sex and headache are associated with lower discharge mRS, while a history of HTN, IPH, and altered mental status are associated with higher discharge mRS. Future studies with larger sample size may help elucidate factors associated with poor neurological outcome.