Reversible Cerebral Vasoconstriction Syndrome Presenting with Multifocal Infarcts: A Case Report

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare and underdiagnosed cause of multifocal infarcts, characterized by transient segmental narrowing of cerebral arteries. This case highlights the diagnostic challenges, as well as the therapeutic response to nimodipine and intra-arterial therapy. Main Symptoms and Clinical Findings: A 54-year-old female presented with a month-long history of confusion, headaches, and weakness. MRI findings revealed multifocal infarcts across multiple vascular territories. Main Diagnoses, Therapeutic Interventions, and Outcomes: RCVS was diagnosed following a diagnostic cerebral angiography, which demonstrated the reversibility of vasospasm with intra-arterial milrinone and verapamil. Treatment with nimodipine resulted in symptom stabilization, and rehabilitation services were initiated. Conclusion: This case underscores the need to consider RCVS early in the diagnostic process for multifocal infarcts. Rapid identification through angiography and prompt initiation of nimodipine therapy can prevent unnecessary interventions and support meaningful neurological recovery. Key Points 1. Reversible cerebral vasoconstriction syndrome can mimic more common pathologies like central nervous system vasculitis or infection, and is often underrecognized. 2. Accurate diagnosis of reversible cerebral vasoconstriction syndrome relies on imaging techniques such as cerebral angiography, which can demonstrate reversible vasospasm, a key diagnostic hallmark. 3. Prompt treatment with calcium channel blockers, such as nimodipine, is essential to both prevent further neurological damage and improve outcomes. Early diagnosis reduces the risk of overtreatment with immunosuppressants and improves functional outcomes.