RCVS₂ Score for Reversible Cerebral Vasoconstriction Syndrome
Distinguishes reversible cerebral vasoconstriction syndrome from other intracranial arteriopathies at admission.
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.
Advice
- Score ≥5: a diagnosis of RCVS is highly likely.
- Score ≤2: a diagnosis of RCVS is highly unlikely and non-RCVS arteriopathy should be considered in the appropriate clinical context.
- Score 3-4: diagnosis is equivocal and a bedside clinical approach is recommended. Other clinical features that independently suggest RCVS include recurrent thunderclap headache, presence of a trigger with normal brain parenchymal imaging, and convexity SAH.
Management
If RCVS is likely, avoid steroids as these may worsen outcomes. In addition, avoid vasoconstrictive medications such as sumatriptan.
Critical Actions
Only apply to patients with new onset arteriopathy on intracranial vascular imaging.