Objective:

To investigate the clinical and demographic factors associated with poor outcomes in reversible cerebral vasoconstriction syndrome (RCVS).

Background:

Although most cases of RCVS result in favorable outcomes, occasional severe neurological deficits, strokes, or fatalities have been reported. However, patients with RCVS and poor outcomes have not been well characterized across studies.

Design/Methods:

This descriptive study included adults (≥18 years) admitted to a comprehensive stroke center from 2016 to 2023 with an index diagnosis of RCVS. Patients who experienced serious complications including subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS), reversible cerebral edema, seizure, or death, were univariately compared to those who did not experience any. Outcomes included discharge disposition (home/home health vs. other) and hospital length of stay (days), with continuous data presented as median (interquartile range).

Results:

The study included 35 RCVS patients with a median age of 44 (30-53) years; 74% were women, and they spent a median of 4 (3-10) days in the hospital. More than half (57%) of the patients had at least one additional neurological diagnosis: SAH (34%), IS (29%), seizure (9%), ICH (9%), reversible brain edema (9%), or death (5%). Overall, 80% of patients were discharged home. Complications were more common in female patients (90% vs. 10%, p=0.02) and correlated with more days on verapamil treatment (5 (3-11) vs. 2 (1-2), p=0.005) compared to those without complications. Patients experiencing complications also had longer hospital stays (9 (4-14) vs. 3 (1-3), p=0.005) and a lower rate of home discharge (65% vs. 100%, p=0.01). Although more patients with complications received steroids (30% vs. 7%), this difference did not reach statistical significance.

Conclusions:

Despite most patients being discharged home, further research is warranted to investigate the higher prevalence of RCVS diagnosis in women and the underlying factors contributing to increased complications among female patients.