Delayed posttraumatic middle cerebral artery vasospasm demonstrated by magnetic resonance angiography: Case report

OBJECTIVE AND IMPORTANCE: Magnetic resonance (MR) angiographic diagnosis 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 cerebral artery vasospasm, the occurrence of which has been rarely described. CLINICAL PRESENTATION: A 42-year-old man sustained head trauma in a traffic accident, which caused a right subdural hematoma. Even though the hematoma was irrigated through one burr hole on Day 10, the patient subsequently developed left hemiparesis in association with dysarthria 4 days after surgery. MR angiography demonstrated decreased flow signal in the right M1 and M2 portions, suggestive of vasospasm. INTERVENTION: The patient underwent intravascular volume expansion/hemodilution 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 suggested that MR angiography is a useful noninvasive method in the evaluation of posttraumatic cerebrovascular disorders, which constitute important secondary insults in head trauma.