Early and Severe Symptomatic Cerebral Vasospasm After Mild Traumatic Brain Injury.

Abstract

Symptomatic cerebral vasospasm has been reported in a low percentage of patients with moderate or severe traumatic brain injury (TBI) as defined by Glasgow Coma Scale (GCS) score. We present a case of mild TBI (GCS score 14) complicated by early and severe symptomatic cerebral vasospasm. A 63-year-old woman was admitted following mild TBI with a GCS score of 14. Concurrent with the onset of sonographic vasospasm, the patient developed severe neurologic symptoms consistent with ischemia of the left middle cerebral artery territory. Confounding causes of these symptoms were excluded. Each occurrence of these symptoms resolved with intra-arterial calcium channel blocker therapy. Early and severe symptomatic vasospasm may occur as a complication of mild TBI. GCS score alone may be an inadequate risk predictor of symptomatic cerebral vasospasm. Aggressive interventional management may be justified, such as with intra-arterial calcium channel blockers, to optimize the likelihood of a favorable outcome.