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Vasospasm following Subarachnoid Hemorrhage - Case 5

A 44 year old man developed the sudden onset of a severe headache followed by nausea and vomiting. Diffuse SAH was present on CT. Five days later, he became lethargic, ataxic and diffusely weak.

           Show the Vasospasm of the Basilar, Basilar Branches and PCAs

Cerebral angiogram of the left vertebral artery, AP view. (Left) Hospital day 5; (Right) Hospital day 1. Note the severe narrowing of the intracranial vertebral and basilar artery on the Day 5 angiogram compared to admission.  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 05/03/06.
The Electronic Curriculum is copyrighted 1998,  Case Western Reserve University School of Medicine.