Endovascular treatment for symptomatic vasospasm following traumatic brain injury: illustrative case

The optimal treatment for cerebral vasospasm (CV) following traumatic brain injury (TBI) has not been established, and management generally follows strategies developed for aneurysmal subarachnoid hemorrhage.

The authors report a case of a patient with traumatic subarachnoid hemorrhage and cerebral contusion who presented with worsening consciousness and disorientation and subsequently developed symptomatic CV on day 6 of hospitalization. MRI and 3D CT demonstrated narrowing of the left internal carotid artery and middle cerebral artery (MCA) with reduced cerebral perfusion. Intra-arterial administration of fasudil hydrochloride yielded a temporary improvement. However, MCA stenosis recurred the next day, requiring percutaneous transluminal balloon angioplasty. Subsequent imaging showed improved cerebral perfusion, and the patient was discharged without delayed cerebral ischemia.

Fluctuations in consciousness or neuropsychological symptoms after TBI should prompt evaluation for CV using perfusion imaging, even in the absence of focal neurological deficits. When a high risk of severe vasospasm accompanied by perfusion reduction is identified, prompt, stepwise therapeutic intervention should be implemented, beginning with the least invasive treatment option to optimize clinical outcomes. https://thejns.org/doi/abs/10.3171/CASE25943.