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Vasospasm following Subarachnoid Hemorrhage - Case 5

A 33 year-old man developed the sudden onset of a severe headache followed by nausea and vomiting. Diffuse subarachnoid blood was present on CT scan. Five days later, he developed increasing weakness on the left side.

Show the Vasospasm of the MCA                 Show the Vasospasm of the ACA

Vasospasm following Subarachnoid Hemorrhage. Cerebral angiogram, Right internal carotid artery injection, AP view. (Left) Hospital day 1; (Right) Hospital day 6. Note the severe narrowing of the right proximal middle cerebral artery and proximal right anterior cerebral artery on the Day 6 angiogram (right) compared to the admission angiogram (left). 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