ADD-ONS / SCALES
RCVS2 score
David Goldemund M.D.
Updated on 21/07/2023, published on 20/01/2023
Updated on 21/07/2023, published on 20/01/2023
- RCVS2 score uses simple clinical and imaging features for DDx between Reversible Cerebral Vasoconstriction Syndrome (RCVS) and primary angiitis of CNS (PACNS) (Rocha, 2019)
- recurrent thunderclap headache (TCH) and single TCH combined with either normal neuroimaging, border zone infarcts, convexial SAH, or vasogenic edema have 100% positive predictive value for diagnosing RCVS or RCVS-spectrum disorder
- if RCVS is likely, avoid steroids and vasoconstrictive medications (such as sumatriptan)
- the presence of subcortical infarcts or abnormal CSF is specific for PACNS
| recurrent or single thunderclap headache | + | 5 |
| – | 0 | |
| intracranial ICA involvement | + | -2 |
| – | 0 | |
| vasoconstrictive trigger identified | + | 3 |
| – | 0 | |
| sex | female | 1 |
| male | 0 | |
| subarachnoid (typically convexial) hemorrhage on imaging |
– | 1 |
| + | 0 |
| RCVS2 Score | RCVS diagnosis |
| ≤ 2 | Negative (specificity 100%, sensitivity 85%, PPV 100%, NPV 71%) |
| 3-4 | Equivocal |
| ≥ 5 | Positive (specificity 99%, sensitivity 90%, PPV 96%, NPV 96%) |
