RCVS₂ Score for RCVS vs CNS Vasculitis
Differentiates reversible cerebral vasoconstriction syndrome (RCVS) from other intracranial arteriopathies, including primary CNS vasculitis (PCNSV), in adults with a new arteriopathy on vascular imaging. Score ≥5 = RCVS (sensitivity 90%, specificity 99%); ≤2 = RCVS excluded (specificity 100%).
Score interpretation
RCVS₂ ≤2 excludes RCVS (specificity 100%, sensitivity 85%) — consider other arteriopathies, including PCNSV.
→ Neurology referral; further work-up of non-RCVS arteriopathy (CSF, vessel-wall imaging, brain biopsy as indicated for PCNSV).
RCVS₂ 3–4 — equivocal (sensitivity 10%, specificity 86% for RCVS).
→ Neurology review; bedside approach (recurrent thunderclap headache, trigger with normal brain imaging, convexity SAH favour RCVS); serial imaging; avoid vasoconstrictive drugs.
RCVS₂ ≥5 — RCVS highly likely (sensitivity 90%, specificity 99%).
→ Avoid vasoconstrictive agents (triptans, ergots, vasopressors, sympathomimetics) and glucocorticoids; calcium channel blockers (nimodipine, verapamil); analgesia; usually resolves within 3 months.
Interpretation bands for the RCVS₂ Score. Apply clinical judgement and local guidance.
References
- Rocha EA et al. RCVS2 score and diagnostic approach for reversible cerebral vasoconstriction syndrome. Neurology. 2019;92(7):e639–e647.
Related
Curated clinical cross-links plus same-class fallbacks.
- Colchicine · Anti-inflammatory — Neutrophilic Dermatoses / Vasculitis
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Edoxaban (AF Stroke Prevention / VTE) · Direct Factor Xa Inhibitor (DOAC)
- Clopidogrel (Stroke/TIA Secondary Prevention) · Antiplatelet (P2Y12 Inhibitor)
- Dabigatran (Stroke Prevention — AF) · Direct Oral Anticoagulant — Thrombin Inhibitor
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.