Cerebral vasospasm with elevated creatine phosphokinase following surgery of unruptured arteriovenous malformation

Delayed cerebral vasospasm associated with marked elevation of serum creatine phosphokinase (CPK) is reported. A 21-year-old man with unruptured arteriovenous malformation (AVM) in the left temporal lobe developed postoperative symptomatic vasospasm lasting for 2 weeks. A postoperative computerized tomography scan showed intraventricular hematoma without subarachnoid hemorrhage in the basal cistern. On day 5 after surgery, the patient developed motor aphasia due to marked vasospasm around the bifurcation of internal carotid artery. On day 7 and 8, serum CPK was elevated as high as 1175 and 1376 IU/l, respectively. On day 35 when he had completely recovered from cerebral vasospasm both clinically and angiographically, the level of CPK was normalized. The causative factors of symptomatic cerebral vasospasm following surgery of unruptured AVM associated with CPK elevation are discussed.