Background and Aims:
Reversible cerebral vascoconstriction syndrome (RCVS) is a condition that typically presents with recurrent thunderclap headache with or without ischaemic or haemorrhagic stroke, subarachnoid haemorrhage (SAH) and seizures.

Methods:
We performed a retrospective case review of patients diagnosed with RCVS who were referred to a tertiary neurological and neurosurgery centre from 2017-2018. Details including the imaging, presenting features, probable triggers and outcome were recorded

Results:
Twelve patients were identified. 92% patients were female; mean age at onset was 54years. All patients presented with thunderclap headache; seven patients had SAH at presentation, with a history of preceding headaches identified in four of these cases; 2 patients had ischaemic stroke at presentation. Eight patients were identified as having triggers; SSRI's (3); phenylephrine (2); doxycycline in combination with nortryptilline; combination of cannabis and amphetamine use with citalopram; and cannabis use alone. Three patients developed symptoms less than two weeks since starting medications. Two patients were identified as having aneurysms which were determined to be incidental and one patient had left internal carotid dissection. All patients were managed conservatively. All had a good outcome with only minor disability.

Conclusions:
Similar to previous cohort studies, the majority of our patients were middle aged, female and 66% were related to vasoactive substances. Three patients had additional incidental vascular findings posing diagnostic difficulty. Use of antidepressants and cannabis is increasing in the UK therefore acute physicians should be aware of this relationship with RCVS in patients presenting with severe headache.

EXPERIENCE OF REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME AT A TERTIARY NEUROLOGY AND NEUROSURGERY CENTRE IN THE UK