Cerebral Vasospasm with Ischemia following a Spontaneous Spinal Subarachnoid HemorrhageReport as inadecuate




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Case Reports in MedicineVolume 2013 2013, Article ID 934143, 5 pages

Case Report

Section of Neurosurgery, The University of Chicago Medicine, Chicago, IL 60637, USA

Department of Neurosurgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL 60201, USA

Received 5 November 2012; Accepted 13 January 2013

Academic Editor: Aaron S. Dumont

Copyright © 2013 Sophia F. Shakur and Hamad I. Farhat. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cerebral vasospasm is a well-known consequence of aneurysmal subarachnoid hemorrhage SAH triggered by blood breakdown products. Here, we present the first case of cerebral vasospasm with ischemia following a spontaneous spinal SAH. A 67-year-old woman, who was on Coumadin for atrial fibrillation, presented with chest pain radiating to the back accompanied by headache and leg paresthesias. The international normalized ratio INR was 4.5. Ten hours after presentation, she developed loss of movement in both legs and lack of sensation below the umbilicus. Spine MRI showed intradural hemorrhage. Her coagulopathy was reversed, and she underwent T2 to T12 laminectomies. A large subarachnoid hematoma was evacuated. Given her complaint of headache preoperatively and the intraoperative finding of spinal SAH, a head CT was done postoperatively that displayed SAH in peripheral sulci. On postoperative day 5, she became obtunded. Brain MRI demonstrated focal restricted diffusion in the left frontoparietal area. Formal angiography revealed vasospasm in anterior cerebral arteries bilaterally and right middle cerebral artery. Vasospasm was treated, and she returned to baseline within 48 hours. Spontaneous spinal SAH can result in the same sequelae typically associated with aneurysmal SAH, and the clinician must have a degree of suspicion in such patients. The pathophysiological mechanisms underlying cerebral vasospasm may explain this unique case.





Author: Sophia F. Shakur and Hamad I. Farhat

Source: https://www.hindawi.com/



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