Cerebral vasospasm and intraluminal filling defects.

Angiographically demonstrated arterial luminal narrowing after operations for intracranial aneurysms is a well-documented phenomenon. However, the mechanisms responsible for neurological dysfunction in the presence of vasospasm have not been clearly defined. Destructive changes have been demonstrated within the walls of vasospastic vessels. These changes consist of desquamation of endothelium and thrombus formation, necrosis of smooth muscle cells, and repair by connective tissue proliferation. A 50-year-old man with two aneurysms on the right carotid artery postoperatively developed ischemic symptoms and on angiography was shown to have multiple intraluminal filling defects and vasospasm. Ephemeral intraluminal thrombus is postulated as the inciting cause of morbidity in cerebral vasospasm in some cases.