A 33 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 developed increasing weakness on the left side.

Cerebral angiogram of the right internal carotid artery, AP view. (Left) Hospital day 6; (Right) Hospital day 1. Note the severe narrowing of the right proximal middle cerebral artery and proximal right anterior cerebral artery on the Day 6 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.
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