Migraine With Vasospasm and Delayed Intracerebral Hemorrhage

Abstract

To the Editor. —Cole and Aube 1 suggested that, in severe migraine attacks, vasospasm may result in ischemic necrosis of intracranial vessel walls, leading to a subsequent vessel rupture responsible for delayed lobar intracerebral hemorrhage, when perfusion pressure is restored. They stated that, except migraine, sub-arachnoid hemorrhage, cerebral trauma, central nervous system infection, drug abuse, toxemia, fibromuscular dysplasia, carotid artery dissection, and cerebral vasculitis have all been associated with the radiographic appearance of spasm of the cerebral arteries. Another possible cause for vasospasm is cerebral embolism. We recently described rupture of the arterial wall in two cases of cerebral embolism. 2 One patient suffered a frontal hematoma. As proposed by Villaret et al, 3 arterial spasm may have occurred at the time of cerebral embolism. The morphological expressions specific to cerebral vasospasm are unknown. Cole and Aube 1 suggested rupture of the arterial wall, secondary to ischemic necrosis. We 2