Profound cerebral vasospasm without radiological evidence of subarachnoid hemorrhage: case report

Profound clinical and radiographic arterial vasospasm in all major intracerebral vessels was identified in a patient with an intraparenchymal hemorrhage that extended into the lateral, 3rd, and 4th ventricles. By computed tomographic criteria and on early cerebrospinal fluid examination, no subarachnoid blood was detected. The temporal appearance of vasospasm was consistent with that typically seen in subarachnoid hemorrhage. Despite hypervolemia and iatrogenic hypertension, cerebral infarction occurred contralateral to the hemorrhage. We conclude that patients without significant subarachnoid hemorrhage (as determined by computed tomographic scanning) may still be at risk for developing vasospasm.