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A 33 year-old man presented with a sudden, severe headache, nausea and vomiting. On angiogram, an anterior communicating artery aneurysm was seen which was then successfully treated surgically the next day. Seven days later, the patient developed progressive headache and right side weakness.
Cerebral angiogram of the left internal carotid artery AP view (Left) 7 days after the surgery; (Right) Pre-operative angiogram. Note the severe narrowing of the left anterior cerebral artery and less so of the middle cerebral artery, compared to the pre-operative angiogram. 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.
The Electronic Curriculum is copyrighted 1998, Case Western Reserve University School of Medicine.