• Susanne Muehlschlegel, Oguzhan Kursun, Mehmet A Topcuoglu, Joshua Fok, and Aneesh B Singhal.
• JAMA Neurol. 2013 Oct 1;70(10):1254-60.

ImportanceReversible cerebral vasoconstriction syndrome (RCVS) is a clinical-angiographic syndrome characterized by recurrent thunderclap headaches and reversible segmental multifocal cerebral artery narrowing. More than 30% of patients with RCVS develop subarachnoid hemorrhage (SAH). Patients with RCVS with SAH (RCVS-SAH) are often misdiagnosed as having potentially ominous conditions such as aneurysmal SAH (aSAH) or cryptogenic "angiogram-negative" SAH (cSAH) owing to overlapping clinical and imaging features.ObjectiveTo identify predictors that can distinguish RCVS-SAH from aSAH and cSAH at the time of clinical presentation.DesignRetrospective analysis of 3 patient cohorts: patients with RCVS (1998-2009), patients with aSAH (1995-2003), and patients with cSAH (1995-2003).SettingAcademic hospital and tertiary referral center.ParticipantsConsecutive patients with RCVS-SAH (n = 38), aSAH (n = 515), or cSAH (n = 93) whose conditions were diagnosed using standard criteria.Main Outcomes And MeasuresMultivariate logistic regression analysis was used to identify predictors that differentiate RCVS-SAH from aSAH and cSAH.ResultsPredictors differentiating RCVS-SAH from aSAH were younger age, chronic headache disorder, prior depression, prior chronic obstructive pulmonary disease, lower Hunt-Hess grade, lower Fisher SAH group, higher number of affected arteries, and the presence of bilateral arterial narrowing. Predictors differentiating RCVS-SAH from cSAH were younger age, female sex, prior hypertension, chronic headache disorder, lower Hunt-Hess grade, lower Fisher SAH group, and the presence of bilateral arterial narrowing.Conclusions And RelevanceWe identified important clinical and imaging differences between RCVS-SAH, aSAH, and cSAH that may be useful for improving diagnostic accuracy, clinical management, and resource utilization.

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