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Reversible cerebral vasoconstriction syndrome — SCE Neurology MCQ

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ModerateStrokeReversible cerebral vasoconstriction syndromeSCE Neurology

A 55-year-old man presented with recurrent thunderclap headaches over one week after starting an SSRI. On examination, neurological examination fluctuated with transient visual symptoms. Initial investigations showed: CTA showed multifocal segmental cerebral arterial narrowing. What is the most appropriate management?

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Correct answer: D — Urgent stroke-unit care with reperfusion and secondary prevention assessment

Urgent stroke-unit care with reperfusion and secondary prevention assessment is the best answer because the vignette describes Reversible cerebral vasoconstriction syndrome: recurrent thunderclap headache with reversible multifocal narrowing suggests RCVS. Specialist counselling about driving and DVLA notification is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Empirical intravenous ceftriaxone after blood cultures and Clear explanation and referral for psychological therapy are less appropriate because they would require different localisation, timing or test findings; Multidisciplinary rehabilitation with goal-setting would fit a different syndrome. Clinical pearl: primary angiitis usually has subacute headache and inflammatory CSF.

Reference: NICE NG128; National Clinical Guideline for Stroke; DVLA Assessing fitness to drive