Reversible cerebral vasoconstriction syndrome presenting with haemorrhage

Reversible cerebral vasoconstriction syndromes are characterized by prolonged but reversible vasoconstriction of the cerebral arteries, presenting typically with thunderclap headache, with or without focal neurological signs or symptoms. They resemble primary central nervous system vasculitis but it is critical to differentiate these two entities. Here we draw attention to intracranial haemorrhage as an important and not uncommon clinical feature in reversible cerebral vasoconstriction syndrome. Four patients with reversible cerebral vasoconstriction syndrome, each presenting to a single unit with intracranial haemorrhage, are described. These descriptions of haemorrhage at presentation of RCVS extend the recognised clinical phenotype and so help to enhance recognition and diagnosis of this often unconsidered disorder.