American Board of Internal Medicine (ABIM) Certification Practice Exam

What disorder often shows clinical overlap with RCVS and presents common headaches?

1. Chronic tension-type headaches

2. Posterior reversible encephalopathy syndrome (PRES)

3. Migraine

4. Cluster headache syndrome

The correct answer is: Posterior reversible encephalopathy syndrome (PRES)

The disorder that often shows clinical overlap with reversible cerebral vasoconstriction syndrome (RCVS) and presents with common headaches is posterior reversible encephalopathy syndrome (PRES). Both RCVS and PRES can present with similar headache patterns, typically severe headaches that may have a sudden onset. The pathophysiology of both conditions involves disruptive changes in cerebral vasculature; in RCVS, there is vasoconstriction of the cerebral arteries often followed by vasodilation, while PRES is characterized by a breakdown of the blood-brain barrier leading to edema. In practice, the overlap in headache presentation can lead to confusion in diagnosis. However, while RCVS is specifically related to reversible vascular changes often triggered by certain factors such as pregnancy, the use of vasoconstrictors, or stress, PRES is associated with a broader range of acute systemic conditions, including hypertension, eclampsia, and renal failure. Thus, clinicians need to consider both entities in situations where a patient presents with acute headache and neurological symptoms. Chronic tension-type headaches, migraines, and cluster headaches typically do not show the same clinical overlap with RCVS as they do not share the same underlying vascular phenomena. Although these headaches may also present with