A 46F, presents to the ED d/t sudden-onset, severe occipital headache & nausea. PMHx is sig for HTN & smoking. PE shows mild disorientation but no focal weakness, sensory loss, or cranial nerve abnormalities. Non-Contrast CT reveals diffuse hyperdensity in the subarachnoid space. CT angio reveals a ruptured ACA aneurysm. The pt undergoes endovascular coiling of the aneurysm. Four days later, there is a sudden deterioration in her level of consciousness & new, right-sided hemiparesis is observed. Repeat CT shows no sig changes.

Which of the following is the most likely cause of this pt's neurological deterioration?

(Arterial thrombosis

OR

Embolism

OR

Vasospasm)

Endovascular coiling of the aneurysm is performed on the patient. Four days later, her degree of consciousness abruptly declines and new right-sided hemiparesis is noticed. Repeat CT reveals no changes in sig. The most likely reason for this patient's neurological decline is vasospasm.

When a blood vessel in the brain narrows, it causes vasospasm, which prevents blood flow. It could happen two weeks after a subarachnoid hemorrhage or a brain aneurysm. If you recently experienced a brain aneurysm rupture or subarachnoid hemorrhage, you are more likely to get a cerebral vasospasm.

Fever, stiff neck, minor confusion, speech problems, one-sided paralysis, and severely compromised consciousness are all indications of a cerebral vasospasm.

Vasospasm can occur upon waking from sleep, when experiencing tension or anxiety, or as a result of hyperventilating. Cocaine, amphetamines, anti-migraine medications, and herbal supplements like ephedra or bitter orange are just a few examples of legal and illicit substances that might cause it.

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