{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T04:46:52Z","timestamp":1778561212416,"version":"3.51.4"},"reference-count":17,"publisher":"Scientific Scholar","issue":"02","license":[{"start":{"date-parts":[[2019,8,20]],"date-time":"2019-08-20T00:00:00Z","timestamp":1566259200000},"content-version":"vor","delay-in-days":141,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Neurosciences in Rural Practice"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Reversible cerebral vasoconstriction syndrome (RCVS) is a disorder of dysregulation of cerebrovascular tone resulting in transient segmental vasoconstriction which resolves in 1\u20133 months. Cerebral edema is an underrecognized complication in RCVS. It is likely multifactorial. This edema can lead to intracranial hypertension that can be refractory to medical management. Limited evidence exists regarding surgical management of intracranial hypertension in RCVS. We present a 29-year-old Caucasian right-handed female patient with a medical history of migraine, polysubstance abuse presented to the emergency department (ED) daily for 3 days with the chief complaint of recurrent thunderclap headache. She declined neuroimaging and lumbar puncture. She was treated for migraine with abortive medications with no improvement. During the third ED visit, she became lethargic with right-sided homonymous hemianopia. Computerized tomography of the brain showed left parietal intracerebral hemorrhage with intraventricular extension, cortical subarachnoid hemorrhage, and diffuse cerebral edema. Digital subtraction angiography showed multifocal moderate-to-severe segmental vasoconstriction suggestive of vasculopathy. Oral verapamil was initiated. Continuous intracranial pressure monitoring showed uncontrolled intracranial hypertension, despite maximal medical management with hyperosmolar therapy, induced coma, and hypothermia. Decompressive hemicraniectomy with duraplasty was performed for refractory intracranial hypertension. We provisionally diagnosed her with RCVS. She was discharged to inpatient rehabilitation with residual right homonymous hemianopia. Transcranial Doppler study during follow-up showed improved mean flow velocities. She continued to have residual cognitive deficits with complete resolution of headache.\n<\/jats:p>","DOI":"10.4103\/jnrp.jnrp_334_18","type":"journal-article","created":{"date-parts":[[2019,3,22]],"date-time":"2019-03-22T04:20:03Z","timestamp":1553228403000},"page":"355-359","source":"Crossref","is-referenced-by-count":3,"title":["Decompression Hemicraniectomy for Refractory Intracranial Hypertension in Reversible Cerebral Vasoconstriction Syndrome"],"prefix":"10.25259","volume":"10","author":[{"given":"Naresh","family":"Mullaguri","sequence":"additional","affiliation":[{"name":"Division of Neurocritical Care, Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anusha","family":"Battineni","sequence":"additional","affiliation":[{"name":"Division of Neurocritical Care, Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pravin","family":"George","sequence":"additional","affiliation":[{"name":"Division of Neurocritical Care, Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher Ryan","family":"Newey","sequence":"additional","affiliation":[{"name":"Division of Neurocritical Care, Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2019,8,20]]},"reference":[{"key":"key-10.4103\/0976-3147.254684-1","first-page":"34","volume-title":"Narrative review: Reversible cerebral vasoconstriction syndromes","author":"Calabrese","year":"2007","journal-title":"Ann Intern Med"},{"key":"key-10.4103\/0976-3147.254684-2","first-page":"1005","volume-title":"Reversible cerebral vasoconstriction syndromes: Analysis of 139 cases","author":"Singhal","year":"2011","journal-title":"Arch Neurol"},{"key":"key-10.4103\/0976-3147.254684-3","first-page":"3091","volume-title":"The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome.A prospective series of 67 patients","author":"Ducros","year":"2007","journal-title":"Brain"},{"key":"key-10.4103\/0976-3147.254684-4","first-page":"645","volume-title":"The link between migraine, reversible cerebral vasoconstriction syndrome and cervical artery dissection","author":"Mawet","year":"2016","journal-title":"Headache"},{"key":"key-10.4103\/0976-3147.254684-5","first-page":"387","volume-title":"Long-term outcomes after reversible cerebral vasoconstriction syndrome","author":"John","year":"2016","journal-title":"Cephalalgia"},{"key":"key-10.4103\/0976-3147.254684-6","first-page":"419","volume-title":"Progressive manifestations of reversible cerebral vasoconstriction syndrome presenting with subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction","author":"Choi","year":"2014","journal-title":"J Korean Neurosurg Soc"},{"key":"key-10.4103\/0976-3147.254684-7","first-page":"454","volume-title":"Blood-brain barrier breakdown in reversible cerebral vasoconstriction syndrome: Implications for pathophysiology and diagnosis","author":"Lee","year":"2017","journal-title":"Ann Neurol"},{"key":"key-10.4103\/0976-3147.254684-8","first-page":"6","volume-title":"Reversible cerebral vasoconstriction syndrome with intracranial hypertension: Should decompressive craniectomy be considered?","author":"Mrozek","year":"2017","journal-title":"Case Rep Neurol"},{"key":"key-10.4103\/0976-3147.254684-9","first-page":"e31","volume-title":"Anovel approach to diagnose reversible cerebral vasoconstriction syndrome: A case series","author":"Kass-Hout","year":"2015","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"key-10.4103\/0976-3147.254684-10","first-page":"657","volume-title":"The typical thunderclap headache of reversible cerebral vasoconstriction syndrome and its various triggers","author":"Ducros","year":"2016","journal-title":"Headache"},{"key":"key-10.4103\/0976-3147.254684-11","first-page":"1207","volume-title":"Isolated cortical vasogenic edema and hyperintense vessel signs may be early features of reversible cerebral vasoconstriction syndrome: Case reports","author":"Murase","year":"2018","journal-title":"Cephalalgia"},{"key":"key-10.4103\/0976-3147.254684-12","first-page":"243","volume-title":"Oxidative stress and increased formation of vasoconstricting F2-isoprostanes in patients with reversible cerebral vasoconstriction syndrome","author":"Chen","year":"2013","journal-title":"Free Radic Biol Med"},{"key":"key-10.4103\/0976-3147.254684-13","first-page":"541","volume-title":"Cerebral vasomotor reactivity in reversible cerebral vasoconstriction syndrome","author":"Topcuoglu","year":"2017","journal-title":"Cephalalgia"},{"key":"key-10.4103\/0976-3147.254684-14","first-page":"161","volume-title":"The need for a rational approach to vasoconstrictive syndromes: Transcranial Doppler and calcium channel blockade in reversible cerebral vasoconstriction syndrome","author":"Marsh","year":"2016","journal-title":"Case Rep Neurol"},{"key":"key-10.4103\/0976-3147.254684-15","first-page":"228","volume-title":"Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome","author":"Singhal","year":"2017","journal-title":"Neurology"},{"key":"key-10.4103\/0976-3147.254684-16","first-page":"142","volume-title":"Intra-arterial milrinone for reversible cerebral vasoconstriction syndrome","author":"Bouchard","year":"2009","journal-title":"Headache"},{"key":"key-10.4103\/0976-3147.254684-17","first-page":"38","volume-title":"Transcranial Doppler ultrasonography as a non-invasive tool for diagnosis and monitoring of reversible cerebral vasoconstriction syndrome","author":"Levin","year":"2013","journal-title":"R I Med J ("}],"container-title":["Journal of Neurosciences in Rural 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