ABSTRACT NUMBER: ESOC2026A40 SYMPOTMATIC VASOSPASM IN TRAUMATIC INTRACEREBRAL HAEMORRHAGE, A CASE REPORT

Abstract Background and aims Cerebral vasospasm and subsequent delayed cerebral ischemia (DCI) have been described as complications of traumatic brain injury and traumatic subarachnoid hemorrhage (tSAH). Methods A 66-year-old male was admitted to our emergency department shortly after being involved in a motor traffic accident, sustaining blunt head trauma with a linear, undisplaced left parietal and temporal fracture and a right temporal cerebral hemorrhagic contusion, associating subarachnoid hemorrhage in both convexities and perimesencephalic and basal cisterns. Glasgow Coma Scale at admission was 15, and there were no more systemic injuries other than a left scapula fracture. Results On the eighth day after admission the patient presented with a sudden onset dysphasia and a right facial nerve palsy. An urgent head CT scan showed a general improvement of the intracranial hemorrhages, and there were no ictal findings in the electroencephalogram. CT brain perfusion showed an area of increased Time-to-maximum and normal cerebral blood volume in the left parietal lobe and left medial cerebral artery vasospasm. Patient was then referred to a neurologic criticalcare unit, where treatment was started with nimodipine and induced hypertention, showing improvement of both symptoms, and vasospasm in ct angiography. Conclusions While aneurysmal SAH is well studied regarding vasospasm and DCI, less is known regarding tSAH and the prevalence of vasospasm and DCI, its consequences and which are the best management strategies. Frequent screening for new onset of symptoms, particularly in patients at high risk of developing DCI is commonly advised. Conflict of interest Nothing to disclose