Abstract
A case of traumatic cerebral arterial spasm presenting with left hemiparesis which developed 13 days after head injury is reported.
A sixty-eight year old man fell from upstairs and was struck on the head. He was admitted to our hospital on the next day. Neurologically, he showed disorientation. A CT-scan on admission revealed traumatic subarachnoid hemorrhage in the interhemisphere, the right sylvian fissure and the right ambient cistern. Carotid angiography performed 7 days after head injury demonstrated diffuse narrowing of bilateral anterior and middle cerebral arteries, and narrowing of supraclinoid portion of left internal carotid artery. The patient developed left hemiparesis 13 days after the head injury, and a CT-scan taken on the 14th day showed low density area in the right frontal lobe. Right carotid angiography 32 days after head injury showed segmental narrowing of the right anterior cerebral artery, however, findings of diffuse narrowing was improved. Bilateral carotid angiography taken 122 days after the accident showed no arterial narrowing. Considering these angiographical findings, the patient seemed to develop ischemic symptoms due to traumatic delayed cerebral arterial spasm. Traumatic subarachnoid hemorrhage and mechanical irritation to cerebral arteries may play an important role in the pathogenesis of such a delayed arterial spasm.
