Posttraumatic cerebrovascular narrowing. A case report and review of the literature

We, neurosurgeons have sometimes confronted with the case of posttraumatic cerebrovascular narrowing or spasm. However, there have been few reports on the pathophysiology of the posttraumatic narrowing or spasm in comparison with those the spasm following the subarachnoid hemorrhage caused by the rupture of the aneurysm. The authors report here a case of temporal lobe contusion who demonstrated cerebrovascular narrowing angiographically at the 21st days after head injury. This 53-years-old male was examined again by angiography one week after the above-described angiography and the narrowing disappeared. The authors reviewed the literature on the posttraumatic cerebrovascular narrowing or spasm. Thirty seven cases have been reported in detail. Under the conditions of these 38 cases including the present case, the pathophysiology of the posttraumatic cerebrovascular narrowing or spasm was discussed. Two theories had been suggested for a long time: one was vasospasm caused by the traumatic subarachnoid hemorrhage and the other by direct mechanical irritation of cerebral artery. Recently, neurogenic factor is thought to take a part of this to a great extent such as hypothalamic dysfunction or dysfunctioning fragile autoregulation mechanism. It is seemed to be that such spasm caused by these mechanism will exist sure. However, in the posttraumatic cerebrovascular vasospasm, there are other accompanying intracranial lesions such as cerebral swelling, cerebral contusion, fracture of the base of the skull and so on. It is not assumed to be so simple environment as the spasm following the rupture of the aneurysm, and also the mechanism of genesis of the posttraumatic cerebrovascular spasm is not to be so simple. Several factors and their duplication will play a role in the mechanism. Further investigation is necessary for the clearness of the problem.