Clinical Spectrum of Reversible Cerebral Vasoconstriction Syndrome With and Without Angiographic Vasoconstriction: A Retrospective Study of 84 Hospitalized Patients.
Takeuchi K, Kikui S, et al. • Brain and behavior • 2026
Patients with reversible cerebral vasoconstriction syndrome without demonstrable vasoconstriction exhibited clinical characteristics, severity indicators, management, and outcomes similar to those with confirmed vasoconstriction, suggesting the two groups may share a common clinical spectrum.
Key Findings
Results
RCVS patients without angiographically demonstrable vasoconstriction did not differ significantly in age or sex distribution from those with confirmed vasoconstriction.
Median age was 51 years in the vasoconstriction group vs. 53 years in the no-vasoconstriction group (p = 0.213)
Female predominance was 80% vs. 78% respectively (p = 1.000)
84 total patients were included: 61 with demonstrable vasoconstriction and 23 without
Patients were hospitalized at a tertiary headache center in Japan between February 2011 and March 2026
Results
The two RCVS groups showed no significant difference in migraine history.
Migraine history was present in 59% of the vasoconstriction group vs. 57% of the no-vasoconstriction group (p = 1.000)
This suggests prior migraine history does not distinguish between the two presentations
Results
Thunderclap headache characteristics were similar between RCVS patients with and without demonstrable vasoconstriction.
Median number of thunderclap headache episodes was 4 in both groups (p = 0.577)
Median interval from the first to the last thunderclap headache was 6 days in both groups (p = 0.460)
Thunderclap headache is the hallmark clinical feature used to diagnose RCVS
Results
Time to hospitalization, length of hospital stay, and calcium channel blocker use were comparable between the two RCVS groups.
Calcium channel blocker use was 98% in the vasoconstriction group vs. 100% in the no-vasoconstriction group (p = 1.000)
No statistically significant differences were found in time to hospitalization or length of hospital stay between groups
Results
Neuroimaging abnormalities and persistent neurological sequelae were similarly low in both RCVS groups.
Neuroimaging abnormalities were present in 8% of the vasoconstriction group vs. 9% of the no-vasoconstriction group (p = 1.000)
Persistent neurological sequelae occurred in 2% of the vasoconstriction group vs. 0% of the no-vasoconstriction group (p = 1.000)
These low rates suggest generally favorable outcomes in both groups
Methods
The study was conducted retrospectively at a single tertiary headache center in Japan, with a study period spanning approximately 15 years.
84 consecutive hospitalized patients with RCVS were included between February 2011 and March 2026
Patients were classified according to the presence or absence of angiographically demonstrable vasoconstriction on magnetic resonance angiography
The retrospective single-center design and relatively small sample size, particularly in the no-vasoconstriction group (n = 23), are acknowledged limitations
What This Means
Reversible cerebral vasoconstriction syndrome (RCVS) is a condition characterized by sudden, severe 'thunderclap' headaches and temporary narrowing of blood vessels in the brain. Diagnosis typically relies on imaging showing this narrowing, but some patients present with all the clinical features of RCVS yet do not show visible blood vessel narrowing on brain scans. This study examined whether these two groups of patients — those with and without visible vessel narrowing — actually differ from each other in meaningful ways.
This research suggests that RCVS patients with and without demonstrable blood vessel narrowing on MRI angiography are remarkably similar across a wide range of clinical measures. The groups had nearly identical headache patterns (both experiencing a median of 4 thunderclap headache episodes over about 6 days), similar rates of prior migraine history, comparable rates of brain imaging abnormalities (around 8–9%), and similarly low rates of lasting neurological problems (0–2%). Both groups were also treated almost identically, with nearly all patients receiving calcium channel blocker medications. These findings held across 84 patients followed at a Japanese headache specialty center over 15 years.
The practical implication of these findings is that patients who meet the clinical criteria for RCVS but lack visible vessel narrowing on imaging may still truly have the condition and may warrant similar clinical attention and management. This research suggests the two presentations could represent different points along the same disease spectrum rather than distinct conditions — though the authors caution that larger prospective studies are needed to confirm these findings before firm conclusions can be drawn.
Takeuchi K, Kikui S, Matsumoto Y, Murakata K, Sugiyama H, Ota K, et al.. (2026). Clinical Spectrum of Reversible Cerebral Vasoconstriction Syndrome With and Without Angiographic Vasoconstriction: A Retrospective Study of 84 Hospitalized Patients.. Brain and behavior. https://doi.org/10.1002/brb3.71775