Post-Traumatic Vasospasm after Mild Brain Trauma, a Lesson Learned.

Abstract

Background: Post-traumatic vasospasm is a frequent secondary injury in patients with traumatic brain injury, occurring in up to 63% of patients and with associated deleterious consequences. Most studies have reported post-traumatic vasospasm in patients with severe or moderate brain trauma; however, there are documented cases of post-traumatic vasospasm in patients with mild traumatic brain injury that support a more aggressive search to prevent deleterious neurological outcomes. Observation(s): The pertinent literature has been reviewed, and an exemplary case has been reported (post-traumatic vasospasm associated with mild brain trauma in an adult patient that subsequently transformed into cerebral ischemia that was managed with endovascular therapy and oral nimodipine without subsequent neurological deterioration). To date, only 4 cases have been described, to our knowledge this is the first literature review so far. Lessons: Given the possibility of post-traumatic vasospasm associated with mild brain trauma, the authors believe that GCS score alone may be an inadequate risk predictor of symptomatic cerebral vasospasm and a more aggressive search should be performed in patients with mild trauma who present with neurological deterioration without apparent cause.