Contribution of MRI in the diagnosis of meningeal bleeding during the vasospasm period

Retrospectively, subarachnoidal hemorrhage can be misdiagnosed when the acu te event did not bring the patient to medical attention, when clinical hist ory is unclear and the CT scan is normal. Moreover, days after subarachnoid hemorrhage, cerebral vasospasm can result in neurological deficits that ar e indistinguishable from that produced by other causes of stroke. We report our experience with two patients who presented with symptoms of ischemia d ire to an arterial vasospasm that followed unrecognized rupture of an intra cranial aneurysm. In both cases, CT Scan failed to detect subarachnoid hemo rrhage while MR detected the presence of signal changes in the subarachnoid al spaces associated with an ischemic stroke in one case. Neurological symp toms resolved completely after aneurysm treatment. MR can be a critical for the diagnosis of stroke secondary to vasospasm in order to prescribe art a dapted treatment, avoid anticoagulant or thrombolytic therapy, and rapidly exclude the recently ruptured aneurysm to protect the patient from the risk of rebleeding.