title: Reversible Cerebral Vasoconstriction Syndrome with Intracranial Hypertension: Should Decompressive Craniectomy Be Considered?
abstract: BACKGROUND
  Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracerebral hemorrhage (ICH) causing intracranial hypertension.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  We report a case of RCVS-related ICH leading to refractory intracranial hypertension. A decompressive craniectomy was performed to control intracranial pressure. We discuss here the management of RCVS with intracranial hypertension. Decompressive craniectomy was preformed to avoid the risky option of high cerebral perfusion pressure management with the risk of bleeding, hemorrhagic complications, and high doses of norepinephrine. Neurological outcome was good.
  
  
  CONCLUSIONS
  RCVS has a complex pathophysiology and can be very difficult to manage in cases of intracranial hypertension. Decompressive craniectomy should probably be considered.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France.
authors.forename: Ségolène
authors.initials: S
authors.lastname: Mrozek
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lonjaret
authors.affiliation: Department of Vascular Neurology, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Jaffre
authors.affiliation: Department of Neuroradiology, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France.
authors.forename: Anne-Christine
authors.initials: AC
authors.lastname: Januel
authors.affiliation: Department of Vascular Neurology, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Raposo
authors.affiliation: Department of Neurosurgery, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France.
authors.forename: Sergio
authors.initials: S
authors.lastname: Boetto
authors.affiliation: Department of Vascular Neurology, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Albucher
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier-Toulouse 3, Toulouse, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Geeraerts
keywords: Decompressive craniectomy; Intracerebral hemorrhage; Intracranial hypertension; Reversible cerebral vasoconstriction syndrome