Angiograms—Lagniappe
Angiography lagniappe: delayed ischemic deficit
Subarachnoid hemorrhage is a deadly disease.
About 90% of nontraumatic subarachnoid hemorrhage results from a ruptured aneurysm. Complications of subarachnoid hemorrhage include:
- rebleeding
- hydrocephalus
- damage from the initial bleed
- delayed ischemic deficit (AKA "vasospasm", DID)
It is DID which we will exemplify in these angiograms.
A gentleman in his 50's presented with subarachnoid hemorrhage. CT scan was diagnostic, showing blood caked in the subarachnoid cisterns at the base of the brain.
An angiogram was obtained, which failed to demonstrate an aneurysm. Note the A1 and M1 segments on this arteriogram.
About a week later, he became comatose. Repeat angiogram showed significant large-vessel vasospasm.
The patient subsequently died from the effects of his delayed ischemic deficit.
Much active research is ongoing to determine the causes and prevention/cures for this deadly complication of subarachnoid hemorrhage.
