case_images: PMC7700025_01
case_images: (a) Postoperative axial T2 sequence magnetic resonance of the brain evidencing reduced flow void diameters of the middle and anterior cerebral arteries surrounding the surgical resection cavity (postoperative day 13); (b) anteroposterior view digital subtraction angiography of a left ICA contrast injection evidencing severe vasospasm of the terminal portion of the ICA (arrow), proximal anterior, and middle cerebral artery (postoperative day 17); (c) postoperative axial T2 sequence magnetic resonance of the brain demonstrating improved flow void caliber of the terminal: internal carotid, middle, and anterior cerebral arteries (3 months postoperatively).
case_images: CRIPE2020-8822874.001.jpg
case_images: PMC7700025_01_CRIPE2020-8822874.001.jpg
case_images: fig1
case_images: In addition, imaging demonstrated diffuse narrowing of the terminal internal carotid arteries (ICAs) and of the proximal MCAs and ACAs, which was suggestive of vasospasm (Figure 1(a)). The left carotid circulation was the most severely affected (Figure 1(b)). Repeat MRI at approximately three months after vasospasm showed postsurgical changes with normalized diameter of the ACA/MCA and without evidence of new restricted diffusion (Figure 1(c)).
case_images: Daily net fluid balance and serum sodium values during the acute period of hospitalization.
case_images: CRIPE2020-8822874.002.jpg
case_images: PMC7700025_01_CRIPE2020-8822874.002.jpg
case_images: fig2
case_images: Following the cerebral angiogram, the patient continued to have a brisk diuresis despite continuous infusion of vasopressin (peaked at 37 mU/kg/hr) and aggressive hydration (Figure 2) with fluctuating neurological examinations.