"Vasospasm Mimic" After Aneurysmal Subarachnoid Hemorrhage

Thomas Ritzenthaler; Florent Gobert; Fréderic Dailler

doi:10.1016/j.wneu.2019.01.034

"Vasospasm Mimic" After Aneurysmal Subarachnoid Hemorrhage

World Neurosurg. 2019 Apr:124:295-297. doi: 10.1016/j.wneu.2019.01.034. Epub 2019 Jan 23.

Authors

Thomas Ritzenthaler¹, Florent Gobert², Fréderic Dailler²

Affiliations

¹ Neurological Intensive Care Unit, Civil Hospices of Lyon, Bron, Cedex, France. Electronic address: thomas.ritzenthaler@chu-lyon.fr.
² Neurological Intensive Care Unit, Civil Hospices of Lyon, Bron, Cedex, France.

PMID: 30684699
DOI: 10.1016/j.wneu.2019.01.034

Abstract

Background: Secondary brain injuries, such as delayed cerebral infarction (DCI), are the leading causes of disability after subarachnoid hemorrhage (SAH). Detecting DCI may be challenging, especially for patients presenting an altered level of consciousness.

Case description: We describe herein the case of a patient who developed acute hemiplegia 4 days after SAH, with raised blood flow velocities on transcranial Doppler, compatible with vasospasm. Finally, full work-up, using computed tomography (CT) scan with perfusion CT and continuous electroencephalography, was consistent with nonconvulsive seizures.

Conclusions: Multiple secondary complications (DCI, seizures, hydrocephalus) may occur after SAH but are clinically difficult to diagnose. A multimodal evaluation (transcranial Doppler, CT or magnetic resonance imaging, electroencephalography) is useful in order to detect and treat late complications.

Keywords: Computed tomography; Continuous EEG; Delayed cerebral ischemia; Subarachnoid hemorrhage; Transcranial Doppler; Vasospasm.