Reversible Cerebral Vasoconstriction Syndrome (RCVS) in Systemic Lupus Erythematosus: A Case Report

Reversible cerebral vasoconstriction syndrome (RCVS) is a neurovascular condition characterized by episodes of sudden and severe headache secondary to transient angiographic changes in the cerebral arteries, which may be accompanied by neurological deficits. Differentiating RCVS from cerebral vasculitis associated with systemic lupus erythematosus (SLE) represents a clinical and radiological challenge due to overlapping manifestations, but it has major therapeutic and prognostic implications. We report the case of a 32-year-old female patient with SLE who developed a thunderclap headache and mild motor deficit. Cranial computed tomography angiography revealed a pattern of arterial irregularity compatible with RCVS, later confirmed by magnetic resonance angiography, which demonstrated complete reversal of the vascular abnormalities. The patient showed favorable clinical evolution with conservative management, avoiding the need for intensive immunosuppressive therapy. This case highlights the importance of early recognition of RCVS in patients with SLE, preventing potentially harmful treatments and enabling a targeted approach for improved clinical outcomes.