American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment to address reversible cerebral vasoconstriction syndrome?

1. Increased fluid intake

2. Normalization of blood pressure

3. Administration of anticoagulants

4. High-dose vitamin therapy

The correct answer is: Normalization of blood pressure

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches and is associated with temporary narrowing of cerebral blood vessels. The most important treatment approach is the normalization of blood pressure. This is crucial because high blood pressure can contribute to ongoing vascular constriction and increase the risk of adverse outcomes. Achieving and maintaining appropriate blood pressure helps to reduce stress on the vascular system, potentially alleviating symptoms and preventing further complications. In the context of managing RCVS, other options are less effective. Increased fluid intake may help with overall hydration but does not specifically target the underlying vasoconstriction issue. The use of anticoagulants does not address the reversible nature of the vasoconstriction and may pose risks, such as bleeding. High-dose vitamin therapy lacks evidence supporting its efficacy in treating RCVS and does not target the vascular changes occurring in this condition. Thus, the focus on blood pressure normalization is integral to treating this syndrome effectively and mitigating the potential for serious complications.