Ogami Kyle, Dofredo Melissa, Moheet Asma M, Lahiri Shouri
Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California, USA.
Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California, USA; Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
World Neurosurg. 2017 May;101:813.e11-813.e14. doi: 10.1016/j.wneu.2017.03.039. Epub 2017 Mar 16.
Symptomatic cerebral vasospasm has been reported in a low percentage of patients with moderate or severe traumatic brain injury (TBI) as defined by Glasgow Coma Scale (GCS) score. We present a case of mild TBI (GCS score 14) complicated by early and severe symptomatic cerebral vasospasm.
A 63-year-old woman was admitted following mild TBI with a GCS score of 14. Concurrent with the onset of sonographic vasospasm, the patient developed severe neurologic symptoms consistent with ischemia of the left middle cerebral artery territory. Confounding causes of these symptoms were excluded. Each occurrence of these symptoms resolved with intra-arterial calcium channel blocker therapy.
Early and severe symptomatic vasospasm may occur as a complication of mild TBI. GCS score alone may be an inadequate risk predictor of symptomatic cerebral vasospasm. Aggressive interventional management may be justified, such as with intra-arterial calcium channel blockers, to optimize the likelihood of a favorable outcome.
据报道，根据格拉斯哥昏迷量表（GCS）评分定义，中度或重度创伤性脑损伤（TBI）患者中出现症状性脑血管痉挛的比例较低。我们报告一例轻度TBI（GCS评分为14）并发早期严重症状性脑血管痉挛的病例。
一名63岁女性因轻度TBI入院，GCS评分为14。在超声显示血管痉挛发作的同时，患者出现了与左大脑中动脉区域缺血一致的严重神经症状。排除了这些症状的混杂原因。每次出现这些症状时，经动脉内钙通道阻滞剂治疗后症状缓解。
早期严重症状性血管痉挛可能作为轻度TBI的并发症出现。仅GCS评分可能不足以作为症状性脑血管痉挛的风险预测指标。积极的介入治疗可能是合理的，如使用动脉内钙通道阻滞剂，以优化获得良好预后的可能性。
