Kim Joong-Goo, Kang Chul-Hoo, Sheen Jae Jon, Song Yunsun, Rhim Jong-Kook
Jeju National University School of Medicine, Jeju, Korea.
Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea.
Neurointervention. 2024 Jul;19(2):123-128. doi: 10.5469/neuroint.2024.00150. Epub 2024 Jun 14.
Delayed ischemic stroke associated with intractable vasospasm after clipping of unruptured intracranial aneurysms (UIAs) has been rarely reported. We report a patient with delayed ischemic stroke associated with intractable vasospasm following UIA clipping. A middle-aged female underwent surgery for unruptured middle cerebral artery bifurcation aneurysms. The patient tolerated the neurosurgical procedure well. Seven days postoperatively, the headache was unbearable; a postcraniotomy headache persisted and abruptly presented with global aphasia and right-sided hemiplegia after a nap. Emergency digital subtraction angiography showed severe luminal narrowing with segmental vasoconstriction, consistent with severe vasospasm. The patient's neurological deficit improved after chemical angioplasty. Neurosurgeons should pay close attention to this treatable/preventive entity after neurological deterioration following UIA clipping, even in patients without subarachnoid hemorrhage.
未破裂颅内动脉瘤（UIA）夹闭术后发生与难治性血管痉挛相关的迟发性缺血性卒中鲜有报道。我们报告1例UIA夹闭术后发生与难治性血管痉挛相关的迟发性缺血性卒中患者。1名中年女性接受了未破裂大脑中动脉分叉部动脉瘤手术。患者对神经外科手术耐受良好。术后7天，头痛难以忍受；开颅术后头痛持续存在，午睡后突然出现完全性失语和右侧偏瘫。急诊数字减影血管造影显示管腔严重狭窄并伴有节段性血管收缩，符合严重血管痉挛表现。化学血管成形术后患者神经功能缺损有所改善。神经外科医生应密切关注UIA夹闭术后神经功能恶化后的这一可治疗/可预防情况，即使是在没有蛛网膜下腔出血的患者中。
