Romanian Neurosurgery (Mar 2024)
Overcoming vasospasm
Abstract
This article presents a case report detailing the endovascular management of severe vasospasm in a 55-year-old patient following the rupture of a right posterior communicating aneurysm. Initially presenting with a Fisher grade 4 subarachnoid haemorrhage, the patient underwent embolization treatment, which resulted in good condition. However, on the 9th day, the patient experienced a sudden deterioration, marked by severe vasospasm and neurological deficits. Diagnostic procedures, including cerebral angiography, revealed extensive vasospasm affecting multiple cerebral arteries. In response, endovascular therapy was initiated, consisting of the intra-arterial administration of Milrinone and Nimodipine. This intervention aimed to alleviate vasospasm and enhance cerebral perfusion. Angiographic imaging post-intervention demonstrated significant improvement in vascular perfusion, correlating with a rapid neurological response. Notably, the patient exhibited immediate improvement in motor deficits and dysarthria following treatment. This case underscores the critical importance of timely recognition and intervention in managing complications post-aneurysmal rupture, particularly severe vasospasm, which poses significant risks of neurological sequelae. The successful application of endovascular techniques, including chemical angioplasty, highlights the evolving landscape of neurointerventional procedures in addressing complex cerebrovascular pathology. The case further emphasizes the necessity of a multidisciplinary approach, involving collaboration between neurosurgery, interventional radiology, and neurocritical care, to optimize patient outcomes in cerebrovascular emergencies. Early detection, prompt intervention, and vigilant post-procedural monitoring remain pivotal in mitigating the risks associated with cerebral aneurysm rupture and its sequelae.
