It occurs in approximately 30% of those surviving the initial haemorrhage, usually between days 4 and 10 after SAH, and resolves by 21 days. Apart from the effects of the initial and recurrent haemorrhage, a much-feared complication is delayed cerebral ischaemia (DCI) and cerebral infarction. TCD has an important role in the non-invasive detection and monitoring of vasospasm after aSAH.Īneurysmal subarachnoid haemorrhage (aSAH) has an incidence of 2–16 per 100,000, a mortality that ranges between 8 and 67%, and significant dependence of 8 and 20% among survivors. The intravenous saline was gradually tailed off and she was subsequently discharged. She was maintained in a euvolemic state and given high volumes of intravenous saline (2.4 L/day). She did not develop any related neurological symptoms or deficits. TCD monitoring of the circle of Willis on day 14 detected very high velocities in the right and left middle cerebral arteries, mean velocity 187 and 141 cm/s, middle cerebral artery/internal carotid artery ratio 6.03 and 4.15, suggestive of severe and moderate vasospasm, respectively. She was given intravenous and then oral nimodipine. She underwent aneurysm coiling that night. Cerebral angiography revealed a 6 × 3 mm aneurysm along the posteromedial aspect of the supraclinoid left internal carotid artery. Computed tomography of the brain showed extensive SAH. Her neurological examination was normal but for severe neck stiffness to passive flexion. On examination, she was already alert and orientated. She subsequently became drowsy and was brought to hospital. We report a 38-year-old lady who developed sudden dizziness and catastrophic generalised headache with neck pain (Pain Score 10/10) while voiding her bowels. Transcranial Doppler (TCD) provides a non-invasive method for detecting and monitoring vasospasm. It has been largely attributed to focal hypoperfusion from reversible cerebral arterial narrowing, “vasospasm,” from the effects of prolonged exposure of the arteries to perivascular blood and oxy-haemoglobin. Delayed cerebral ischaemia (DCI) and cerebral infarction is a much-feared complication of aneurysmal subarachnoid haemorrhage (aSAH).
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