Unruptured aneurysm: vasospasm after surgery and endovascular treatment. A case report.

Abstract

Arterial cerebral vasospasm in different pathological conditions other than subarachnoid haemorrhage (SAH) caused by ruptured aneurysm is uncommon. The haemodynamicsclinical consequences of such conditions makes a quick diagnosis, vital to choose the best therapeutic strategy. A 55-year-old woman presented chronic headache. Computed tomography scan revealed an image suggesting carotid aneurysm on the left which was confirmed by digital angiography in the ophthalmic segment. Programmed surgery of clipping aneurysm was carried out without complications. The patient remained without morbidity for the first 16 hours, then she developed progressive aphasia, right motor deficit and loss of consciousness. The angiography showed severe vasospasm in horizontal segments of anterior cerebral artery (A1) and middle cerebral artery (Ml). Vasodilatation with topic papaverine by selective microcatheterism in Al and M1 segments achieved clinical-radiological success in time. The patient was discharged on the seventh day, with Glasgow Coma Scale (GCS) 15/15 and slight right hemiparesis. Vasospasm pathogenesis in conditions other than SAH from ruptured aneurysm remains a scientific frontier for ongoing research. We know about the short half-life effect of papaverine and believe that the success in this particular case was accurate and definite due to the fact that the mechanism of the spasm presented no bleeding in the subarachnoid cisterns.