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Vasospasm following Subarachnoid Hemorrhage - Case 4

A 42 year-old man developed left lower leg weakness one week after successful coiling of an anterior communicating artery aneurysm that had bled.

Note the Vasospasm of the Proximal ACA                                                   Note the Absence of Flow in the Distal ACA

Vasospasm following Subarachnoid Hemorrhage. Cerebral angiogram, Right internal carotid artery injection; (Right) AP view; (Left) Lateral view. Note the severe narrowing of the left anterior cerebral artery. Also note on the lateral view, the relative absence of any flow in the anterior cerebral artery territory (see the patient's CT scan). 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 11/18/06.
Copyrighted 2006. David C Preston