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.
