Posttraumatic Vasospasm Detected by Continuous Brain Tissue Oxygen Monitoring: Treatment with Intraarterial Verapamil and Balloon Angioplasty

• Published in: Neurocritical care Vol. 10; no. 1; pp. 61 - 69
• Main Authors: Shahlaie, Kiarash, Boggan, James E., Latchaw, Richard E., Ji, Cheng, Muizelaar, J. Paul
• Format: Journal Article
• Language: English
• Published: New York Humana Press Inc 01.02.2009; Springer Nature B.V
• Subjects: Adult; Anesthesia; Angioplasty; Angioplasty, Balloon; Blood; Brain Injuries - complications; Brain Injuries - diagnosis; Brain Injuries - metabolism; Carotid arteries; Coma; Contusions; Critical Care Medicine; Female; Hematoma; Humans; Hypothermia; Hypoxia; Intensive; Internal Medicine; Intracranial pressure; Medical imaging; Medicine; Medicine & Public Health; Monitoring, Physiologic; Neurology; Oxygen Consumption - physiology; Practical Pearl; Thoracic surgery; Traumatic brain injury; Vasodilator Agents - therapeutic use; Vasospasm, Intracranial - diagnosis; Vasospasm, Intracranial - etiology; Vasospasm, Intracranial - therapy; Veins & arteries; Verapamil - therapeutic use; P; Traumatic brain injury; Angioplasty; Vasospasm; Verapamil; Brain tissue oxygen; O
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-008-9138-z

Introduction Posttraumatic vasospasm (PTV) is a relatively common event following traumatic brain injury (TBI) that has been strongly correlated with worse neurological outcome in many studies. However, vasospasm continues to be an under-recognized source of secondary injury following TBI, and currently published guidelines do not address screening or management strategies for PTV. Brain tissue oxygen (P bt O 2 ) monitoring probes allow for continuous screening for cerebral hypoxia following TBI, but their use as a monitor for PTV has not been previously described. Methods Case report and literature review. Results We present a case of PTV identified by persistent low P bt O 2 despite aggressive medical therapy. Computed tomography and digital subtraction angiography confirmed severe cerebral arterial vasospasm involving both anterior and posterior circulations. The patient was successfully treated with serial intraarterial therapy including balloon angioplasty and verapamil infusion. Conclusion Posttraumatic vasospasm should be included in the differential diagnosis of cerebral hypoxia (e.g., low P bt O 2 ) following TBI. Management strategies for PTV may include early, aggressive intraarterial therapies including drug infusion and balloon angioplasty.