Delayed Traumatic Intracranial Arterial Spasm

Abstract

Case 1: A 26-year-old man was admitted with multiple injuries. A computed tomography (CT) scan revealed severe fractures of the cranial base and a faint subarachnoid hemorrhage. On day 14 the patient began complaining of left motor weakness. Angiography revealed remarkable angiospasm not only in the C1, A1, and M1 portions bilaterally, but also in the basilar artery. The left hemiparesis recovered well and follow-up angiography after about 1 month showed that the angiospasm had disappeared completely. Case 2: A 48-year-old man was admitted with head trauma. A CT scan revealed a distinct subarachnoid hemorrhage in the right sylvian fissure and a small intracerebral hematoma in the left temporal lobe. Right carotid angiography on day 12 revealed segmental angiospasm in the right C1 portion and a few branches of the middle cerebral artery. The patient recovered well neurologically without showing any local signs. Follow-up angiography after about 2 weeks showed that the spasm had disappeared completely. The pathogenesis of traumatic arterial spasm is not yet well understood. The following three factors, however, have been postulated: 1) subarachnoid hemorrhage, 2) mechanical injury to the arterial wall, and 3) dysfunction of the hypothalamus. The cases reported here indicate that besides subarachnoid hemorrhage, mechanical injury to the arterial wall could be an important factor.