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‘Diagnostic anchoring’ and a delayed diagnosis of reversible cerebral vasoconstriction syndrome
  1. Shiwei Huang1,
  2. Cameron Williams1,
  3. James Thomas2,
  4. Najwa Khalil2,
  5. Jason Wenderoth1,3 and
  6. Mark Parsons2,4
  1. 1Department of Interventional Radiology, Liverpool Hospital, Liverpool, New South Wales, Australia
  2. 2Department of Neurology, Liverpool Hospital, Liverpool, New South Wales, Australia
  3. 3Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, New South Wales, Australia
  4. 4South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Mark Parsons; mark.parsons{at}


We present a case of a woman in her 60s with acute left hemispheric ischaemic stroke syndrome due to tandem occlusions of the proximal left internal carotid artery and left middle cerebral artery. This was treated with emergent carotid artery stenting and endovascular clot retrieval. The patient made a complete recovery and was discharged home only to represent a few days later with focal neurological symptoms, profound headache and labile blood pressure. The diagnostic and management challenges of reversible cerebral vasoconstriction syndrome, including imaging assessment and the importance of avoiding ‘diagnostic anchoring’ are discussed.

  • Neuroimaging
  • Headache (including migraines)
  • Stroke
  • Interventional radiology
  • Radiology

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  • Contributors SH drafted the first version of the manuscript including editing of clinical images (no original diagrams or algorithms were presented in our manuscript). All other authors were actively participating in case discussion and manuscript revision. The following authors gave final approval of the manuscript: SH, CW, JT, NK, JW, MP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.