Recurrence of reversible cerebral vasoconstriction syndrome A long-term follow-up study

Objective: We aimed to investigate whether reversible cerebral vasoconstriction syndrome (RCVS) could recur and to identify the potential predictors of recurrence in a large cohort of patients. Methods: This study followed a cohort of 210 patients with RCVS in a hospital-based headache center from 2000 to 2012. All patients were regularly followed up by telephone after remission for RCVS and were particularly asked to return to our hospital immediately if they developed new acute, severe (i.e., thunderclap-like) headaches. Sequential neuroimaging studies were used to determine whether the patients had recurrent RCVS. Results: One hundred sixty-eight patients were successfully followed. The response rate was 80.8%, and the mean follow-up period was 37.5 +/- 24.4 (range 6-131) months. Eighteen patients (10.7%) returned to our hospital because of new thunderclap-like headaches, and 9 (5.4% of the total 168, and 50% of 18) were confirmed to have recurrent RCVS that occurred a mean 40.9 +/- 27.2 (median 35, range 6-87) months after the initial bout. The incidence rate was 1.71 per 100 person-years (95% confidence interval 1.68-1.75). Having sexual activities as a trigger for thunderclap headaches (hazard ratio = 5.68, 95% confidence interval 1.11-29.15, p = 0.038) was an independent predictor of recurrent RCVS. None of the patients with recurrent RCVS developed cerebrovascular complications. Conclusions: Recurrent RCVS should be considered when patients with RCVS develop new thunderclap-like headaches. Having sexual activities as a trigger for RCVS is a potential predictor of recurrent RCVS.