CT Perfusion-Guided Endovascular Treatment of Symptomatic Cerebral Vasospasm: A Case Study

Introduction

Cerebral vasospasm is a rare but serious complication of perimesencephalic non-aneurysmal subarachnoid hemorrhage (SAH). In a groundbreaking study, researchers explored the effectiveness of CT perfusion-guided endovascular treatment in managing this condition.

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Understanding the Case Study

A 36-year-old woman presented with a four-day history of severe headache. Initial CT scans confirmed SAH around the midbrain cisterns, with normal CT angiography and digital subtraction angiography (DSA).

Key findings:

• Day 11: Patient developed dysarthria and slight right hemiparesis. A repeat CT perfusion (CTP) scan indicated reversible ischemia in the left middle cerebral artery (MCA) territory.
• Day 12: Severe vasospasm in the supraclinoid segment of both internal carotid arteries and the M1 segment of the left MCA was identified via DSA.
• Treatment:
  • Intra-arterial nimodipine injection led to mild angiographic improvement.
  • Due to symptom recurrence, balloon angioplasty was performed using a Hyperglide balloon, resulting in complete symptom resolution.
• Outcome: The patient was discharged two weeks later with no residual neurological deficits.

Clinical Implications and Expert Insights

CT perfusion is increasingly recognized as a vital tool in diagnosing and guiding treatment for cerebral vasospasm. The American Stroke Association highlights the importance of advanced imaging in stroke and cerebrovascular management.

By integrating CTP scans with endovascular procedures, clinicians can identify critically hypoperfused but salvageable brain tissue, improving patient outcomes.

Key References and Study Access

Read the full study at https://doi.org/10.29328/journal.acr.1001033.

Further research articles and case studies can be explored in the Clinical Medicine Case Reports Journal.

Conclusion and Call to Action

This case reinforces the efficacy of endovascular treatment in managing symptomatic vasospasm secondary to non-aneurysmal SAH. CT perfusion remains a crucial diagnostic modality in optimizing treatment strategies.

Explore more studies at https://www.clinmedcasereportsjournal.org/acr and join the conversation by sharing your thoughts in the comments below!

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