Delayed cerebral vasospasm following traumatic acute subdural hematoma: case report

Authors

  • Kaima Suzuki Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
  • Milan Lepić Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
  • Hiroki Sato Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
  • Shinya Tabata Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
  • Tatsuki Kimura Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
  • Hiroki Kobayashi Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
  • Keijiro Yoshida Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
  • Masayoshi Fukuoka 1. Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
  • Nobuyuki Yahagi 1. Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
  • Takuma Maeda 1. Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
  • Hidetoshi Ooigawa Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
  • Hiroki Kurita Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama

DOI:

https://doi.org/10.55005/v2i1.3

Keywords:

cerebral vasospasm, traumatic brain injury, subdural hematoma, delayed cerebral ischemia

Abstract

Introduction: Post-traumatic vasospasm is a rare but known ischemic damage after severe traumatic brain injury that independently predicts patients’ outcome. Although the pathogenesis and risk factors have not been elucidated, some reports describe relationship between the occurrence of vasospasm and traumatic subarachnoid haemorrhage. Here, we report a case of vasospasm in a patient with acute subdural hematoma in which traumatic subarachnoid haemorrhage was not recognized both surgically and radiologically.
Case Report: A 60-year-old male was admitted for head trauma. Neurologically, he was somnolence and showed left hemiparesis. Computerized tomography (CT) revealed large acute subdural hematoma in the left side associated with midline-shift. He underwent urgent craniotomy and hematoma evacuation. Postoperatively, he recovered well with resolution of neurological symptoms. Follow-up CT revealed complete removal of hematoma. However, his level of consciousness deteriorated on the 5th day after surgery. CT showed no ischemic lesion, but 3D-CT angiography revealed diffuse vasospasm in the right middle cerebral artery. Subsequently, his neurological condition recovered gradually and he was discharged ambulatory on the 9th day after the surgery. Follow-up angiography showed the spasm had disappeared completely.
Conclusion: Post-traumatic vasospasm without traumatic SAH was described. The etiology and pathogenesis of this fairly rare condition associated with head trauma is discussed.

References

Findlay JM, Nisar J, Darsaut T. Cerebral Vasospasm: A Review. Can J Neurol Sci. 2016;43(1):15-32. doi: 10.1017/cjn.2015.288.

Baggott CD, Aagaard-Kienitz B. Cerebral vasospasm. Neurosurg Clin N Am. 2014;25(3):497-528. doi: 10.1016/j.nec.2014.04.008.

Perrein A, Petry L, Reis A, Baumann A, Mertes P, Audibert G. Cerebral vasospasm after traumatic brain injury: an update. Minerva Anestesiol. 2015;81(11):1219-28. doi:

Witten AJ, Ordaz JD, Alentado VJ, Bohnstedt B. Intracranial Vasospasm After Evacuation of Acute Spontaneous Subdural Hematoma. Cureus. 2021;13(5):e15284. doi: 10.7759/cureus.15284.

Al-Mufti F, Amuluru K, Changa A, Lander M, Patel N, Wajswol E, et al. Traumatic brain injury and intracranial hemorrhage-induced cerebral vasospasm: a systematic review. Neurosurg Focus. 2017;43(5):E14. doi: 10.3171/2017.8.FOCUS17431.

Shahlaie K, Keachie K, Hutchins IM, Rudisill N, Madden LK, Smith KA, et al. Risk factors for posttraumatic vasospasm. J Neurosurg. 2011;115(3):602-11. doi: 10.3171/2011.5.JNS101667.

Oertel M, Boscardin WJ, Obrist WD, Glenn TC, McArthur DL, Gravori T, et al. Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon: a prospective study performed in 299 patients. J Neurosurg. 2005;103(5):812-24. doi: 10.3171/jns.2005.103.5.0812.

Zubkov AY, Lewis AI, Raila FA, Zhang J, Parent AD. Risk factors for the development of post-traumatic cerebral vasospasm. Surg Neurol. 2000;53(2):126-30. doi: 10.1016/s0090-3019(99)00178-0.

Armonda RA, Bell RS, Vo AH, Ling G, DeGraba TJ, Crandall B, et al. Wartime traumatic cerebral vasospasm: recent review of combat casualties. Neurosurgery. 2006;59(6):1215-25; discussion 25. doi: 10.1227/01.NEU.0000249190.46033.94.

Vitošević F, Milošević-Medenica S. Traumatic intracranial aneurysms associated with traffic accidents and endovascular management options. Serbian J Neurosurg. 2022;1(1):27-32. doi: 10.55005/sjns.v1i1.5.

Chugh C, Agarwal H. Cerebral vasospasm and delayed cerebral ischemia: Review of literature and the management approach. Neurol India. 2019;67(1):185-200. doi: 10.4103/0028-3886.253627.

Wilkins RH. Cerebral vasospasm in conditions other than subarachnoid hemorrhage. Neurosurg Clin N Am. 1990;1(2):329-34. doi:

Wilson JL, Feild JR. The production of intracranial vascular spasm by hypothalamic extract. J Neurosurg. 1974;40(4):473-9. doi: 10.3171/jns.1974.40.4.0473.

Bracard S, Schmitt E. Vasospasm and delayed consequences. Interv Neuroradiol. 2008;14 Suppl 1(Suppl 1):17-22. doi: 10.1177/15910199080140S105.

Al-Mufti F, Amuluru K, Lander M, Mathew M, El-Ghanem M, Nuoman R, et al. Low Glasgow Coma Score in Traumatic Intracranial Hemorrhage Predicts Development of Cerebral Vasospasm. World Neurosurg. 2018;120:e68-e71. doi: 10.1016/j.wneu.2018.07.143.

Armin SS, Colohan AR, Zhang JH. Vasospasm in traumatic brain injury. Acta Neurochir Suppl. 2008;104(13):421-5. doi: 10.1007/978-3-211-75718-5.

Downloads

Published

2022-10-11

How to Cite

Suzuki, K., Lepić, M., Sato, H., Tabata, S., Kimura, T., Kobayashi, H., Yoshida, K., Fukuoka, M., Yahagi, N., Maeda, T., Ooigawa, H., & Kurita, H. (2022). Delayed cerebral vasospasm following traumatic acute subdural hematoma: case report. Neurohirurgija - The Serbian Journal of Neurosurgery, 2(1), 9–12. https://doi.org/10.55005/v2i1.3

Issue

Section

Reports