Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches and constriction of cerebral arteries related with stroke. Hypothesis: To describe the patients characteristics, radiological findings and clinical course of adults patients with fatal RCVS. Methods: A systematic literature search using MEDLINE and EMBASE was performed up to March 6, 2017. Studies reporting RVCS in adult patients with fatal outcomes were included. Results: Of 368 initially identified studies, 121 full text articles were reviewed, of which 6 publications describing 10 subjects were entered. The vast majority of the reports came from the U.S except for one report form Denmark that included a male patient. Almost all the cases occurred during pregnancy or post-partum. Only 40% subjects had a history of migraine. The clinical presentation involved headache although only 20% presented with thunderclap headache and 14.3% had seizures. A CT was performed in 71.4% of the patients and the rest had an MRI. Imaging results were diverse with trend towards PRESS and ICH. The main course of treatment included steroids in 70% of the subjects and only 30% received nimodipine. Time to death ranged from 7 to 24 days with a median of 11 days. Conclusion: Most of the time RCVS has a benign course, however we described fatal cases from the literature mostly related with post-partum angiopathy. We found a trend in the onset with PRESS, ICH and diffuse cerebral edema with less subjects using nimodipine as main treatment. We described some markers for worse prognosis. Table 1 Description of studies Fig. 1