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    Patent Pending

    RCVS₂ Score for Reversible Cerebral Vasoconstriction Syndrome

    Distinguishes reversible cerebral vasoconstriction syndrome from other intracranial arteriopathies at admission.

    INSTRUCTIONS

    To use the score, patients must have a first presentation of abnormal intracranial vascular imaging and be 18–55 years old. The score has not been tested outside this age range.

    When to Use
    Pearls/Pitfalls
    Why Use

    Use in patients 18-55 years old with a new presentation of intracranial arteriopathy on intracranial vascular imaging to differentiate RCVS from non-RCVS causes of intracranial arteriopathy.

    • Detailed history-taking is imperative, with clear characterization of the hyperacute onset of severe headache and identification of vasoconstrictive triggers. 
    • Failure to identify a trigger that is present may change the diagnosis from RCVS to non-RCVS arteriopathy. Clinical judgment should be used when identifying triggers since vasoconstrictive potency can vary and a temporal relationship may be important.
    • A new angiographic abnormality (CTA, MRA, or catheter cerebral angiogram) is required to apply the RCVS2 score.
    • Intermediate scores of 3-4 were equivocal with a sensitivity of 10% and specificity of 86% for diagnosing RCVS.
    • RCVS may have normal intracranial vascular imaging early or late in the course, in which case the RCVS2 score is inapplicable. 
    • Not applicable to children <18 or adults >55.
    • Note that intracranial internal carotid artery narrowing scores negative points (-2) to avoid misdiagnosis in patients with Moyamoya disease.
    • Provides a discriminatory clinical tool using variables that are readily available at first presentation.
    • Early distinction between RCVS and non-RCVS arteriopathies is diagnostically challenging and has important management implications particularly because steroids, often used in non-RCVS arteriopathies, worsen outcomes in RCVS. 
    • A score ≥5 diagnosed RCVS with 90% sensitivity and 99% specificity. A score ≤2 excluded RCVS with 85% sensitivity and 100% specificity.
    • Accurately distinguishes RCVS from its closest mimic, primary angiitis of the CNS (PACNS). 

    Absent
    0
    Present
    +5
    Not affected
    0
    Affected
    -2
    No
    0
    Yes
    +3
    Male
    0
    Female
    +1
    Absent
    0
    Present
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Aneesh B. Singhal

    About the Creator

    Aneesh B. Singhal, MD, is the vice-chair of quality and safety for the department of neurology and director of the Comprehensive Stroke Center at Massachusetts General Hospital in Boston. He is also on the board of trustees of Spaulding Rehabilitation Hospital and the Mass General Brigham Continuing Care Network. Dr. Singhal's primary research is focused on the treatment of advanced stroke, imaging of acute stroke, and stroke present in young adults.

    To view Dr. Aneesh B. Singhal's publications, visit PubMed

    Are you Dr. Aneesh B. Singhal? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Dr. Eva A. Rocha

    About the Creator

    Eva A. Rocha, MD, PhD, completed this study as a neurology research fellow at Massachusetts General Hospital in Boston. She is now a practicing neurologist at Hospital Israelita Albert Einstein in Brazil and professor of Neurology at Centro Universitario São Camilo. Dr. Rocha's primary research is focused on the treatment of cerebrovascular diseases.

    To view Dr. Eva A. Rocha's publications, visit PubMed

    Are you Dr. Eva A. Rocha? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Jose Biller, MD, FACP, FAAN, FANA, FAHA
    • Michael Teitcher, MD
    About the Creator
    Dr. Aneesh B. Singhal
    Are you Dr. Aneesh B. Singhal?
    Dr. Eva A. Rocha
    Are you Dr. Eva A. Rocha?
    Content Contributors
    • Jose Biller, MD, FACP, FAAN, FANA, FAHA
    • Michael Teitcher, MD