DELAYED POSTTRAUMATIC MIDDLE CEREBRAL-ARTERY VASOSPASM DEMONSTRATED BY MAGNETIC-RESONANCE ANGIOGRAPHY - CASE-REPORT

OBJECTIVE AND IMPORTANCE: Magnetic resonance (MR) angiographic diagnos is is a noninvasive method having high sensitivity and specificity in the defection of various cerebrovascular disorders. This is the first report of MR angiographic detection of delayed posttraumatic middle ce rebral artery vasospasm, the occurrence of which has been rarely descr ibed. CLINICAL PRESENTATION: A 42-year-old man sustained head trauma i n a traffic accident, which caused a right subdural hematoma. Even tho ugh the hematoma was irrigated through one burr hole on Day 10, the pa tient subsequently developed left hemiparesis in association with dysa rthria 4 days after surgery. MR angiography demonstrated decreased flo w signal in the right M1 and M2 portions, suggestive of vasospasm. INT ERVENTION: The patient underwent intravascular volume expansion/hemodi lution therapy for 3 days. CONCLUSION: After the therapy, the ischemic symptoms completely disappeared. Follow-up study confirmed resolution of the flow signal in the right middle cerebral artery. It is suggest ed that MR angiography is a useful noninvasive method in the evaluatio n of posttraumatic cerebrovascular disorders, which constitute importa nt secondary insults in head trauma.