Objective:

Cerebral vasospasm is a common sequela of aneurysmal subarachnoid hemorrhage or traumatic brain injury. This can result in cerebral ischemia leading to neurological and/or cognitive deficits with long-standing debilitation. A few cases of delayed cerebral vasospasm have been reported after resection of cranial based tumors: a rare phenomenon.

Background:

37 yo female presented with progressive headache, episodes of right arm jerking, shuffling gait, memory deficits, and dizziness for the past ten months. Neuroimaging revealed a large left frontotemporal meningioma with significant midline shift. She underwent resection via left periorbital approach. Five days postop she developed a persistent low flow CSF leak, necessitating endoscopic endonasal fat graft repair and a lumbar drain. During the next few days, she developed resistant new-onset hypertension needing continuous Nicardipine infusion. She remained neurologically intact although the blood pressure remained elevated with increasing Nicardipine requirements. Post operative day ten, she developed acute onset right sided hemiplegia and global aphasia beginning with intermittent episodes of speech arrest. She was taken for emergent neuroendovascular intervention after demonstration of near occlusive stenosis on CTA. Initial angiogram demonstrated severe flow limiting vasospasm in the left M1, M2 and distal M3 segments of the middle cerebral artery with a large filling deficit in the left hemisphere. She was treated with balloon angioplasty and intraarterial administration of Verapamil and Nicardipine with near complete vasospasm resolution and excellent filling within the left hemisphere. Her exam returned to baseline including speech and right sided strength with an MRI Brain demonstrating no significant infarct burden.

Design/Methods:

NA

Results:

NA

Conclusions:

While delayed cerebral vasospasm post resection of cranial based tumors is rare, a high index of suspicion should be maintained in these situations with delayed neurological deterioration. Early identification with acute neuroimaging and timely initiation of treatment can lead to excellent neurological outcomes with reversal of all symptoms.