Neurological Surgery No Shinkei Geka Volume 19, Issue 5 (May 1991)

Delayed Traumatic Vasospasm:Correlation between cerebral vasospasm and contusion Takehide ONUMA 1 , Shigeki KAGAWA 2 , Masatoshi OBA 3 1Department of Neurosurgery, Sendai City Hospital 2Department of Neurosurgery, Municipal Sakaka Hospital 3Department of Neurosurgery, Tohoku University School of Medicine Keyword: Head injury , Cerebral vasospasm , Subarachnoid hemorrhage , Cerebral contusion pp.435-442
Published Date 1991/5/10
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The pathogenesis of delayed traumatic vasopasm is not yet fully understood. We present six cases of de-layed traumatic symptomatic vasospasm along with CT scan and angiographic findings. The cases ranging in age from 16 to 78 years all had head injury caused by traffic accidents.

The Glasgow coma scale on admission was 9 - 15 ex-cept in one severe case GCS 6. Initial CT scans were obtained on the day of injury in four patients and on the 2nd and 3rd clays in the other two cases respective-ly. There was no distinct subarachnoid hemorrrhage in the suprasellar cistern.

Subarachnoid hemorrhage in the Sylvian cistern was observed with particular care in all patients. However the severity of subarachnoid hemorrhage was mild (isodensity or slight high densisty by CT) in 4 cases. Brain contusions on CT scan were observed in the tem-poral and / or frontal region of 5 of 6 patients. Ischemic symtoms occurred during the period between 5 and 13 days after head injury.

The cerebral angiogram taken after the occurrence of these symptoms revealed spasms in all patients, the spasm being bilateral in 2 of them. Spasms were recog-nized on the main arteries at the base of the brain such as Cl, MI, M2 and A1. In 5 cases, the cerebral contu-sion and the spasm were located on the same side. An-giographically the vasospasms lasted 2 to 5 weeks. The prognosis based on the Glasgow outcome scale was good recovery in 3 patients and moderate disability in one. Two elderly patients with bilateral spasms were in a vegetative state and severe disability, respectively. From these results, the following conclusions were reached :

1) Traumatic vasospasm frequently occurring in se-vere cases of head trauma may also occur in relatively mild cases.

2) Traumatic vasospasms occur in cases of slight su- barachnoicl hemorrhage. The side affected by brain contusion corresponded well with that of the spasms.

3) Delayed traumatic vasospasms may be caused notonly by subaracnoid hemorrhage but also by brain con-tusion, that is, by mechanically injured vessels and che-mical substances deriving from the damaged tissues.

Copyright © 1991, Igaku-Shoin Ltd. All rights reserved.


Neurological Surgery 脳神経外科
19巻5号 (1991年5月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院