Journal of Japanese Congress on Neurological Emergencies
Online ISSN : 2187-5006
Print ISSN : 1619-3067
ISSN-L : 1619-3067
Case Report
Endovascular treatments for multiple severe vasospasms in traumatic brain injury: a case report
Yutaka IgarashiGaku MatsumotoTsukasa IkedaShin SatoAkihiro WatanabeTakeshi WadaGo SuzukiAkihiro HashizumeKohjiro SekiHidetaka OndaAkira FuseMakoto KawaiHiroyuki Yokota
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2012 Volume 24 Issue 3 Pages 91-96

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Abstract

Background: Cerebral vasospasm following severe traumatic brain injury contributes to a significant rise in morbidity and mortality rate. Japanese and US guidelines for the management of severe traumatic brain injury do not specify any treatments for post-traumatic vasospasm; therefore, patients with cerebral vasospasm following severe traumatic brain injury are administered endovascular treatment in line with that administered for vasospasm following aneurysmal subarachnoid hemorrhage.
Clinical presentation: Following a fall, a 21-year-old woman presented to us with traumatic subarachnoid hemorrhage, basal skull fracture, multiple trauma with hemorrhagic shock, and an initial Glasgow Coma Scale score of 6.
Intervention: Eight days after the injury, the patient developed left hemiparesis with disturbed consciousness. An angiogram revealed severe vasospasm of basilar artery (BA) and the bilateral internal carotid arteries (ICAs), middle cerebral arteries (MCAs), and anterior cerebral arteries (ACAs). She underwent transluminal balloon angioplasty and intra-arterial infusion of nicardipine in BA, ICAs, MCAs and BA. Significant clinical improvement was observed following this endovascular treatment. A follow-up angiogram did not reveal any sings of vasospasm, and the patient was discharged 53 days after injury for further rehabilitation.
Conclusion: Endovascular treatment, including transluminal balloon angioplasty and intra-arterial infusion of a vasodilator is safe and efficient treatment for symptomatic post-traumatic vasospasm.

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© 2012 The Japanese Congress on Neurological Emergencies
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