Uncommon Cerebral Vasospasms after Neurosurgical Operations: A Diagnostic Challenge. A Case Report

Case Report

Austin J Clin Neurol 2019; 7(1): 1136.

Uncommon Cerebral Vasospasms after Neurosurgical Operations: A Diagnostic Challenge. A Case Report

Ehlert A1*, Gessert M2, Starekova J3, Borgert A4, Ehlert-Gamm A5 and Manthei G1

¹Department of Neurosurgery, Asklepios Hospital St, George, Germany

²Department of Neurology, Asklepios Georg Hospital Nord, Germany

³Department of Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Germany

4Department of Anesthesiology and Intensive Care Medicine, Asklepios Klinik St, Georg, Germany

5Doctors Office of Neurology and Psychiatry, Christinenstr, Berlin, Germany

*Corresponding author: Angelika Ehlert, Department of Neurosurgery, Asklepios Hospital St. Georg, Lohmuehlenstr. 5, 20099 Hamburg, Germany

Received: April 21, 2020; Accepted: May 06, 2020; Published: May 13, 2020


Background: Even neurosurgical standard operations, not giving reason for cerebral Vasospasms (VS) per se, may involve symptomatic spasms with subsequent disseminated subcortical infarcts away from the operation site and should give reason to consider vasospasms.

Methods & Clinical Setting: Occurrence of subcortical, small spot-shaped infarcts offside the operation area drew suspicion on symptomatic cerebral VS Transcranial Doppler-sonography (TCD), cranial Computed Tomography Angiography (CTA), CT perfusion (CTP) and Magnetic Resonance Tomography (MRI) angiography (MRA) and perfusion (MRP) proved vasospasms and standard vasospasmolytic therapy was induced.

Results: Probably, ipsilateral sequential VS of the proximal and distal Medial Cerebral Artery (MCA) led to unexpected infarcts. Pattern of infarcts were initially disseminated sub-cortical evolving to segmential lesions. Even though infarcts established could not be changed under vasospasmolytic therapy, there did not occur any further infarcts in vulnerable brain-at-risk areas identified by perfusion CT. For the first patient, the associated neurological deficits receded partly, the second one recovered completely.

Conclusion: Subcortical, progressive infarcts after neurosurgical interventions could be induced by vasospasms of the large brain-supplying vessels without an obvious trigger. Disseminated “embolic-like” infarcts should give reason to consider cerebral VS for saving at least brain-at-risk areas.


Even following neurosurgical interventions usually not implicating a risk for vasospasm, perfusion-disturbing vs of brainsupplying arteries with corresponding brain ischemia may occur.

This complication is of major importance for the patient concerned and a challenge for the treating physician, since the conventional framework conditions for vs are missing [1-6], but diagnosis and potential therapy in case of imminent brain infarcts should take place immediately to save brain-at-risk-areas. We would like to raise awareness of this rare and serious but treatable complication.

Subjects and Methods

Patient 1: A male patient, 46 years, no pre-existing diseases, active smoker. Rupture and hemorrhage by cavernoma in right Sylvian fissure bleeding 4 weeks ago, no remaining neurological deficit (Figure 1a). For microsurgical resection, the fissure was widely opened for avoiding the use of a brain retractor and minimization of manipulation on the superficial sylvian branches of MCA. The M3 branches were exposed, covered by gauze sponges, the proximal segments were not been visualized. The surrounding brain tissue of cavernoma was slightly brownish. A minor bleeding of the cavernoma whilst mobilization and en-bloc resection occurred, but blood clots in the fissure removed by irrigation. A local administrable vasodilatator was not used.