Reversible cerebral vasoconstriction syndrome (RCVS) is an uncommon disease presentation, typically seen in female adults, characterized by transient cerebral blood vessel narrowing.1,2 Certain anesthetic pain management drugs are contraindicated in patients with a history of RCVS due to their potential to worsen symptoms. Gaps remain in anesthetic management as no standardized pain management protocols exist for patients with a history of RCVS.3 We herein report the unique case of a female patient with a history of RCVS complicated by multi-focal acute ischemic stroke and subarachnoid hemorrhage, who underwent lumbar microdiscectomy surgery. Her presentation required a carefully tailored perioperative anesthetic and pain regimen to avoid triggering her RCVS and reduce the risk of perioperative complications, including compromised cerebral perfusion.

A literature review was done, using Google Scholar and PubMed, to further investigate other anesthetic management courses utilized in cases where RCVS was of concern in patients (Figure 2).