Delayed cerebral vasospasm following traumatic acute subdural hematoma: case report

Abstract

Introduction: Post-traumatic vasospasm is a rare but known ischemic damage after severe traumatic brain injury that independently predicts patients’ outcome. Although the pathogenesis and risk factors have not been elucidated, some reports describe relationship between the occurrence of vasospasm and traumatic subarachnoid haemorrhage. Here, we report a case of vasospasm in a patient with acute subdural hematoma in which traumatic subarachnoid haemorrhage was not recognized both surgically and radiologically.Case Report: A 60-year-old male was admitted for head trauma. Neurologically, he was somnolence and showed left hemiparesis. Computerized tomography (CT) revealed large acute subdural hematoma in the left side associated with midline-shift. He underwent urgent craniotomy and hematoma evacuation. Postoperatively, he recovered well with resolution of neurological symptoms. Follow-up CT revealed complete removal of hematoma. However, his level of consciousness deteriorated on the 5th day after surgery. CT showed no ischemic lesion, but 3D-CT angiography revealed diffuse vasospasm in the right middle cerebral artery. Subsequently, his neurological condition recovered gradually and he was discharged ambulatory on the 9th day after the surgery. Follow-up angiography showed the spasm had disappeared completely.Conclusion: Post-traumatic vasospasm without traumatic SAH was described. The etiology and pathogenesis of this fairly rare condition associated with head trauma is discussed.