A 44 year-old man presented with a sudden, severe headache, nausea and vomiting. On angiogram, no source of bleeding was seen. Five days later, he developed progressive aphasia and a right hemiparesis.

Cerebral angiogram of the left internal carotid artery (Left: AP, Right: Lateral). 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.

Revised 05/01/06.
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