Angiographic demonstration of acute phase of intracranial arterial spasm following aneurysm rupture

Case report

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✓ A case documenting the acute phase of intracranial arterial spasm following rupture of an aneurysm arising from the left internal carotid artery is reported. The patient deteriorated due to recurrent hemorrhage while undergoing angiography 12 hours after the initial aneurysm rupture. The acute deterioration was accompanied by dilatation of the ipsilateral pupil and occurred during injection of contrast material. There was delayed filling of the middle cerebral artery complex along with this narrowing. The arterial narrowing was confirmed to have completely disappeared on an angiographic series performed 14 minutes after the first series of films. The etiology of the acute vasospasm is discussed.

Article Information

Address reprint requests to: Mamoru Taneda, M.D., Department of Neurosurgery, Hanwa Memorial Hospital, Karita-7, Sumiyoshi-ku, Osaka 558, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Computerized tomography scans before angiography showing blood in the subarachnoid space and in the ventricles.

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    Sequential right carotid angiograms with left carotid compression, anteroposterior views. Upper Left: A film made 2 seconds after injection showing extreme narrowing of the intradural portion of the left internal carotid artery (ICA) as well as lack of filling of the distal portion of the left middle cerebral artery (MCA). Upper Right: A film made at 3 seconds showing no apparent change in the degree of the narrowing of the left ICA. There is no filling of the distal branches of the left MCA as opposed to good filling of the distal branches of the other major arteries. Lower Left: A film made at 5 seconds showing an increase in the diameter of the left ICA. Lower Right: A film made at 7 seconds showing delayed filling of the distal branches of the left MCA.

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    Right carotid angiogram with left carotid compression, oblique view, 8 minutes after the first series of films which revealed arterial narrowing. The caliber of the left internal carotid artery is still small but enlarged and there is simultaneous filling of the distal branches of the left middle cerebral artery (arrows).

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    Left: Left carotid angiogram with right carotid compression, anteroposterior view, 14 minutes after the first series of films which revealed arterial narrowing. The left internal carotid artery (ICA) is of normal size. Right: Left carotid angiogram, oblique view, obtained by rotating the head 60° to the left side, 40 minutes after the first series of films which revealed narrowing of the left ICA. The neck of the aneurysm is seen arising from the left ICA (arrow). Note that the previously narrowed artery has returned to a normal caliber.

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    Computerized tomography scans after angiography showing an increased amount of blood, especially in the left lateral ventricle, revealing evidence of recurrent hemorrhage.

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