A 54 year-old man presented with a sudden, severe headache, nausea and vomiting. Later that day, he underwent successful clipping of a posterior communicating artery aneurysm. However, seven days post-op, he developed progressive aphasia and a right hemiparesis.

Cerebral angiogram of the left internal carotid artery (Left: pre-op; Right: 7 days post-op). Note the severe narrowing of the top of the carotid, MCA and ACA vessels. This is vasospasm, a known delayed complication of SAH. If severe enough, vasospasm may lead to progressive ischemia and stroke. In some cases, an acute stroke then results in edema, herniation and death. Vasospasm is typically treated with volume expansion, mild evaluation of BP, and in some case, angioplasty of the involved blood vessels. All of these treatments are better tolerated after the aneurysm has been successfully treated. 

Revised 05/20/06.
The Electronic Curriculum is copyrighted 1998,  Case Western Reserve University School of Medicine.