|
A 54 year-old man presented with a sudden, severe headache, nausea and vomiting. Later the same day, he underwent successful clipping of a posterior communicating artery aneurysm. Seven days post-op, however, he developed aphasia and a right hemiparesis. |
| Vasospasm following Subarachnoid Hemorrhage. Cerebral angiogram,
Left internal carotid
artery injection. (Left) pre-op; (Right) 7 days post-op. Note the severe narrowing
of the
top of the carotid, middle cerebral, and anterior cerebral arteries. This is the
picture of vasospasm, a known delayed
complication of subarachnoid hemorrhage (SAH). ICA = internal carotid artery,
MCA = middle cerebral artery, ACA = anterior cerebral artery. Vasospasm is reported to occur in as many as 70% of patients with SAH and is clinically symptomatic in as many as 30% of patients. It most commonly occurs 4-14 days after the onset of bleeding. If severe enough, vasospasm may lead to progressive ischemia and stroke. In some cases, the acute stroke then results in edema, herniation and death. Vasospasm is typically treated with the calcium channel blocker nimodipine, volume expansion, mild elevation of blood pressure, and in some cases, angioplasty of the involved blood vessels. All of these treatments are better tolerated after the aneurysm has been successfully treated. |
Revised
11/29/06.
Copyrighted 2006. David C Preston