Skip to main content

Advertisement

SpringerLink
Log in

Posttraumatic Vasospasm Detected by Continuous Brain Tissue Oxygen Monitoring: Treatment with Intraarterial Verapamil and Balloon Angioplasty

  • Practical Pearl
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Introduction

Posttraumatic vasospasm (PTV) is a relatively common event following traumatic brain injury (TBI) that has been strongly correlated with worse neurological outcome in many studies. However, vasospasm continues to be an under-recognized source of secondary injury following TBI, and currently published guidelines do not address screening or management strategies for PTV. Brain tissue oxygen (PbtO2) monitoring probes allow for continuous screening for cerebral hypoxia following TBI, but their use as a monitor for PTV has not been previously described.

Methods

Case report and literature review.

Results

We present a case of PTV identified by persistent low PbtO2 despite aggressive medical therapy. Computed tomography and digital subtraction angiography confirmed severe cerebral arterial vasospasm involving both anterior and posterior circulations. The patient was successfully treated with serial intraarterial therapy including balloon angioplasty and verapamil infusion.

Conclusion

Posttraumatic vasospasm should be included in the differential diagnosis of cerebral hypoxia (e.g., low PbtO2) following TBI. Management strategies for PTV may include early, aggressive intraarterial therapies including drug infusion and balloon angioplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Columnella F, Delzanno GB, Gaist G, Piazza G. Angiography in traumatic cerebral lacerations with special regard to some less common aspects. Acta Radiol Diagn (Stockh). 1963;1:239–47.

    Google Scholar 

  2. Frenidenfelt H, Sundctrom R. Local and general spasm in the internal carotid artery system following trauma. Acta Radiol. 1963;1:278–83.

    Google Scholar 

  3. Marshall LF, Bruce DA, Bruno L, Langfitt TW. Vertebrobasilar spasm: a significant cause of neurological deficit in head injury. J Neurosurg. 1978;48:560–4.

    CAS  PubMed  Google Scholar 

  4. Wilkins RH, Odom GL. Intracranial arterial spasm associated with craniocerebral trauma. J Neurosurg. 1970;32:626–33.

    CAS  PubMed  Google Scholar 

  5. Wilkins RH. Cerebral vasospasm in conditions other than subarachnoid hemorrhage. Neurosurg Clin N Am. 1990;1(2):329–34.

    CAS  PubMed  Google Scholar 

  6. Suwanwela C, Suwanwela N. Intracranial arterial narrowing and spasm in acute head injury. J Neurosurg. 1972;36:314–23.

    CAS  PubMed  Google Scholar 

  7. Vajramani GV, Chandramouli BA, Jayakumar PN, Kolluri S. Evaluation of posttraumatic vasospasm, hyperaemia, and autoregulation by transcranial colour-coded duplex sonography. Br J Neurosurg. 1999;13:468–73.

    CAS  PubMed  Google Scholar 

  8. Hadani M, Bruk B, Ram Z, Knoller N, Bass A. Transiently increased basilar artery flow velocity following severe head injury: a time course transcranial Doppler study. J Neurotrauma. 1997;14:629–36.

    CAS  PubMed  Google Scholar 

  9. Chan KH, Dearden NM, Miller JD. The significance of posttraumatic increase in cerebral blood flow velocity: a transcranial Doppler ultrasound study. Neurosurgery. 1992;30:697–700. doi:10.1097/00006123-199205000-00008.

    Article  CAS  PubMed  Google Scholar 

  10. Compton JS, Teddy PJ. Cerebral arterial vasospasm following severe head injury: a transcranial Doppler study. Br J Neurosurg. 1987;1:435–9. doi:10.3109/02688698708999633.

    Article  CAS  PubMed  Google Scholar 

  11. Martin NA, Doberstein C, Zane C, Caron MJ, Thomas K, Becker DP. Posttraumatic cerebral arterial spasm: transcranial Doppler ultrasound, cerebral blood flow, and angiographic findings. J Neurosurg. 1992;77:575–83.

    CAS  PubMed  Google Scholar 

  12. Weber M, Grolimund P, Seiler RW. Evaluation of posttraumatic cerebral blood flow velocities by transcranial Doppler ultrasonography. Neurosurgery. 1990;27:106–12. doi:10.1097/00006123-199007000-00015.

    Article  CAS  PubMed  Google Scholar 

  13. Zubkov AY, Pilkington AS, Bernanke DH, Parent AD, Zhang J. Posttraumatic cerebral vasospasm: clinical and morphological presentations. J Neurotrauma. 1999;16:763–70.

    CAS  PubMed  Google Scholar 

  14. Rozsa L, Gombi R, Szabo S, Sztermen M. Vasospasm after head injury studied by transcranial Doppler sonography. Radiol Diagn (Berl). 1989;30:151–7.

    CAS  Google Scholar 

  15. Romner B, Bellner J, Kongstad P, Sjoholm H. Elevated transcranial Doppler flow velocities after severe head injury: cerebral vasospasm or hyperemia? J Neurosurg. 1996;85:90–7.

    CAS  PubMed  Google Scholar 

  16. Martin NA, Patwardhan RV, Alexander MJ, et al. Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm. J Neurosurg. 1997;87:9–19.

    CAS  PubMed  Google Scholar 

  17. Grolimund P, Weber M, Seiler RW, Reulen HJ. Time course of cerebral vasospasm after severe head injury. Lancet. 1988;1:1173. doi:10.1016/S0140-6736(88)91995-2.

    Article  CAS  PubMed  Google Scholar 

  18. Soustiel JF, Shik V. Posttraumatic basilar artery vasospasm. Surg Neurol. 2004;62:201–6; discussion 6. doi:10.1016/j.surneu.2003.10.037.

  19. Oertel M, Boscardin WJ, Obrist WD, et al. Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon: a prospective study performed in 299 patients. J Neurosurg. 2005;103:812–24.

    PubMed  Google Scholar 

  20. Soustiel JF, Shik V, Feinsod M. Basilar vasospasm following spontaneous and traumatic subarachnoid haemorrhage: clinical implications. Acta Neurochir (Wien). 2002;144:137–44; discussion 44. doi:10.1007/s007010200016.

  21. Armonda RA, Bell RS, Vo AH, et al. Wartime traumatic cerebral vasospasm: recent review of combat casualties. Neurosurgery. 2006;59:1215–25; discussion 25. doi:10.1227/01.NEU.0000249190.46033.94.

    Google Scholar 

  22. Pasqualin A, Vivenza C, Rosta L, Licata C, Cavazzani P, Da Pian R. Cerebral vasospasm after head injury. Neurosurgery. 1984;15:855–8.

    Article  CAS  PubMed  Google Scholar 

  23. Kordestani RK, Martin NA, McBride DQ. Cerebral hemodynamic disturbances following penetrating craniocerebral injury and their influence on outcome. Neurosurg Clin N Am. 1995;6:657–67.

    CAS  PubMed  Google Scholar 

  24. Martin NA, Doberstein C, Alexander M, et al. Posttraumatic cerebral arterial spasm. J Neurotrauma. 1995;12:897–901.

    CAS  PubMed  Google Scholar 

  25. Lee JH, Martin NA, Alsina G, et al. Hemodynamically significant cerebral vasospasm and outcome after head injury: a prospective study. J Neurosurg. 1997;87:221–33.

    CAS  PubMed  Google Scholar 

  26. Brain Trauma Foundation. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24(Suppl 1):S1–106. doi:10.1089/neu.2006.0209.

    Google Scholar 

  27. Chan KH, Dearden NM, Miller JD. Transcranial Doppler-sonography in severe head injury. Acta Neurochir Suppl (Wien). 1993;59:81–5.

    CAS  Google Scholar 

  28. Chan KH, Dearden NM, Miller JD, Midgley S, Piper IR. Transcranial Doppler waveform differences in hyperemic and nonhyperemic patients after severe head injury. Surg Neurol. 1992;38:433–6. doi:10.1016/0090-3019(92)90111-Y.

    Article  CAS  PubMed  Google Scholar 

  29. European Study Group. A multicenter trial of the efficacy of nimodipine on outcome after severe head injury. The European Study Group on Nimodipine in Severe Head Injury. J Neurosurg. 1994;80:797–804.

    Google Scholar 

  30. Ojha BK, Jha DK, Kale SS, Mehta VS. Trans-cranial Doppler in severe head injury: evaluation of pattern of changes in cerebral blood flow velocity and its impact on outcome. Surg Neurol. 2005;64:174–9; discussion 9. doi:10.1016/j.surneu.2004.11.030.

  31. Sander D, Klingelhofer J. Cerebral vasospasm following post-traumatic subarachnoid hemorrhage evaluated by transcranial Doppler ultrasonography. J Neurol Sci. 1993;119:1–7. doi:10.1016/0022-510X(93)90185-2.

    Article  CAS  PubMed  Google Scholar 

  32. Steiger HJ, Aaslid R, Stooss R, Seiler RW. Transcranial Doppler monitoring in head injury: relations between type of injury, flow velocities, vasoreactivity, and outcome. Neurosurgery 1994;34:79–85; discussion 85–6.

    Google Scholar 

  33. Zurynski YA, Dorsch NW, Pearson I. Incidence and effects of increased cerebral blood flow velocity after severe head injury: a transcranial Doppler ultrasound study I. Prediction of post-traumatic vasospasm and hyperemia. J Neurol Sci. 1995;134:33–40. doi:10.1016/0022-510X(95)00172-9.

    Article  CAS  PubMed  Google Scholar 

  34. Arutiunov AI, Baron MA, Majorova NA. The role of mechanical factors in the pathogenesis of short-term and prolonged spasm of cerebral arteries. J Neurosurg. 1974;40:459–72.

    CAS  PubMed  Google Scholar 

  35. Echlin FA. Vasospasm and focal cerebral ischemia: an experimental study. Arch Neurol Psychiatry. 1942;47:77–96.

    Google Scholar 

  36. Symon L. An experimental study of traumatic cerebral vascular spasm. J Neurol Neurosurg Psychiatry. 1967;30:497–505.

    Article  CAS  PubMed  Google Scholar 

  37. Arseni C, Maretsis M, Horvath L. Post-traumatic intracranial arterial spasm: report of three cases. Acta Neurochir (Wien). 1971;24:25–35. doi:10.1007/BF01403138.

    Article  CAS  Google Scholar 

  38. Lewin W. Vascular lesions in head injuries. Br J Surg. 1968;55:321–31. doi:10.1002/bjs.1800550502.

    Article  CAS  PubMed  Google Scholar 

  39. Gaetani P, Rodriguez Y, Baena R, et al. Endothelin and aneurysmal subarachnoid haemorrhage: a study of subarachnoid cisternal cerebrospinal fluid. J Neurol Neurosurg Psychiatry. 1994;57:66–72.

    Article  CAS  PubMed  Google Scholar 

  40. Seifert V, Loffler BM, Zimmermann M, Roux S, Stolke D. Endothelin concentrations in patients with aneurysmal subarachnoid hemorrhage. Correlation with cerebral vasospasm, delayed ischemic neurological deficits, and volume of hematoma. J Neurosurg. 1995;82:55–62.

    CAS  PubMed  Google Scholar 

  41. Gomez CR, Backer RJ, Bucholz RD. Transcranial Doppler ultrasound following closed head injury: vasospasm or vasoparalysis? Surg Neurol. 1991;35:30–5. doi:10.1016/0090-3019(91)90198-I.

    Article  CAS  PubMed  Google Scholar 

  42. Zubkov AY, Lewis AI, Raila FA, Zhang J, Parent AD. Risk factors for the development of post-traumatic cerebral vasospasm. Surg Neurol. 2000;53:126–30. doi:10.1016/S0090-3019(99)00178-0.

    Article  CAS  PubMed  Google Scholar 

  43. Eisenberg HM, Gary HE Jr, Aldrich EF, et al. Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg. 1990;73:688–98.

    CAS  PubMed  Google Scholar 

  44. Mattioli C, Beretta L, Gerevini S, et al. Traumatic subarachnoid hemorrhage on the computerized tomography scan obtained at admission: a multicenter assessment of the accuracy of diagnosis and the potential impact on patient outcome. J Neurosurg. 2003;98:37–42.

    PubMed  Google Scholar 

  45. Morris GF, Bullock R, Marshall SB, Marmarou A, Maas A, Marshall LF. Failure of the competitive N-methyl-D-aspartate antagonist Selfotel (CGS 19755) in the treatment of severe head injury: results of two phase III clinical trials. The Selfotel Investigators. J Neurosurg. 1999;91:737–43.

    CAS  PubMed  Google Scholar 

  46. Kakarieka A, Braakman R, Schakel EH. Clinical significance of the finding of subarachnoid blood on CT scan after head injury. Acta Neurochir (Wien). 1994;129:1–5. doi:10.1007/BF01400864.

    Article  CAS  Google Scholar 

  47. Kistler JP, Crowell RM, Davis KR, et al. The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology. 1983;33:424–36.

    CAS  PubMed  Google Scholar 

  48. Taneda M, Kataoka K, Akai F, Asai T, Sakata I. Traumatic subarachnoid hemorrhage as a predictable indicator of delayed ischemic symptoms. J Neurosurg. 1996;84:762–8.

    CAS  PubMed  Google Scholar 

  49. Harders AG, Gilsbach JM. Time course of blood velocity changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound. J Neurosurg. 1987;66:718–28.

    Article  CAS  PubMed  Google Scholar 

  50. Weir B, Grace M, Hansen J, Rothberg C. Time course of vasospasm in man. J Neurosurg. 1978;48:173–8.

    CAS  PubMed  Google Scholar 

  51. Bakshi A, Mahapatra AK. Basilar artery vasospasm after severe head injury: a preliminary transcranial Doppler ultrasound study. Natl Med J India. 1998;11:220–1.

    CAS  PubMed  Google Scholar 

  52. Zurynski YA, Dorsch NW, Fearnside MR. Incidence and effects of increased cerebral blood flow velocity after severe head injury: a transcranial Doppler ultrasound study II. Effect of vasospasm and hyperemia on outcome. J Neurol Sci. 1995;134:41–6. doi:10.1016/0022-510X(95)00178-X.

    Article  CAS  PubMed  Google Scholar 

  53. Muttaqin Z, Arita K, Uozumi T, et al. Vasospasm after traumatic subarachnoid haemorrhage: transcranial Doppler evaluation. Case report. Neurosurg Rev. 1991;14:321–5. doi:10.1007/BF00383273.

    Article  CAS  PubMed  Google Scholar 

  54. Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien). 1989;100:12–24. doi:10.1007/BF01405268.

    Article  CAS  Google Scholar 

  55. Jakobsen M, Enevoldsen E, Dalager T. Spasm index in subarachnoid haemorrhage: consequences of vasospasm upon cerebral blood flow and oxygen extraction. Acta Neurol Scand. 1990;82:311–20.

    CAS  PubMed  Google Scholar 

  56. Soustiel JF, Shik V, Shreiber R, Tavor Y, Goldsher D. Basilar vasospasm diagnosis: investigation of a modified “Lindegaard Index” based on imaging studies and blood velocity measurements of the basilar artery. Stroke. 2002;33:72–7. doi:10.1161/hs0102.100484.

    Article  PubMed  Google Scholar 

  57. Sarrafzadeh AS, Sakowitz OW, Kiening KL, Benndorf G, Lanksch WR, Unterberg AW. Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients? Crit Care Med. 2002;30:1062–70. doi:10.1097/00003246-200205000-00018.

    Article  PubMed  Google Scholar 

  58. Vajkoczy P, Horn P, Thome C, Munch E, Schmiedek P. Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003;98:1227–34.

    PubMed  Google Scholar 

  59. Meixensberger J, Vath A, Jaeger M, Kunze E, Dings J, Roosen K. Monitoring of brain tissue oxygenation following severe subarachnoid hemorrhage. Neurol Res. 2003;25:445–50. doi:10.1179/016164103101201823.

    Article  PubMed  Google Scholar 

  60. Vath A, Kunze E, Roosen K, Meixensberger J. Therapeutic aspects of brain tissue pO2 monitoring after subarachnoid hemorrhage. Acta Neurochir Suppl (Wien). 2002;81:307–9.

    CAS  Google Scholar 

  61. Muench E, Horn P, Bauhuf C, et al. Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Crit Care Med. 2007;35:1844–51; quiz 52. doi:10.1097/01.CCM.0000275392.08410.DD.

  62. Hoelper BM, Hofmann E, Sporleder R, Soldner F, Behr R. Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: case report. Neurosurgery. 2003;52:970–4; discussion 4–6. doi:10.1227/01.NEU.0000053033.98317.A3.

  63. Wilensky EM, Bloom S, Leichter D, et al. Brain tissue oxygen practice guidelines using the LICOX CMP monitoring system. J Neurosci Nurs. 2005;37:278–88.

    PubMed  Google Scholar 

  64. Doppenberg EM, Zauner A, Watson JC, Bullock R. Determination of the ischemic threshold for brain oxygen tension. Acta Neurochir Suppl (Wien). 1998;71:166–9.

    CAS  Google Scholar 

  65. Doppenberg EMR, Zauner A, Bullock R, Ward JD, Fatouros PP, Young HF. Correlations between brain tissue oxygen tension, carbon dioxide tension, pH, and cerebral blood flow—a better way of monitoring severely injured brain? Surg Neurol. 1998;49:650–4. doi:10.1016/S0090-3019(97)00355-8.

    Article  CAS  PubMed  Google Scholar 

  66. Stiefel MF, Udoetuk JD, Spiotta AM, et al. Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg. 2006;105:568–75. doi:10.3171/jns.2006.105.4.568.

    Article  PubMed  Google Scholar 

  67. Brain Trauma Foundation. Guidelines for the management of severe traumatic brain injury. X. Brain oxygen monitoring and thresholds. J Neurotrauma. 2007;24(1):S65–70.

    Google Scholar 

  68. Rosenthal G, Hemphill JCIII, Sorani M, et al. Brain tissue oxygen tension is more indicative of oxygen diffusion than oxygen delivery and metabolism in patients with traumatic brain injury. Crit Care Med. 2008;36:1917–24. doi:10.1097/CCM.0b013e3181743d77.

    Article  CAS  PubMed  Google Scholar 

  69. Macpherson P, Graham DI. Arterial spasm and slowing of the cerebral circulation in the ischaemia of head injury. J Neurol Neurosurg Psychiatry. 1973;36:1069–72.

    Article  CAS  PubMed  Google Scholar 

  70. Macpherson P, Graham DI. Correlation between angiographic findings and the ischaemia of head injury. J Neurol Neurosurg Psychiatry. 1978;41:122–7.

    Article  CAS  PubMed  Google Scholar 

  71. Kochanowicz J, Krejza J, Mariak Z, Bilello M, Lyson T, Lewko J. Detection and monitoring of cerebral hemodynamic disturbances with transcranial color-coded duplex sonography in patients after head injury. Neuroradiology. 2006;48:31–6. doi:10.1007/s00234-005-0009-4.

    Article  CAS  PubMed  Google Scholar 

  72. Lee KH, Lukovits T, Friedman JA. “Triple-H” therapy for cerebral vasospasm following subarachnoid hemorrhage. Neurocrit Care. 2006;4:68–76. doi:10.1385/NCC:4:1:068.

    Article  PubMed  Google Scholar 

  73. Yamada K, Harada M, Hasegawa S, Ushio Y. Delayed posttraumatic middle cerebral artery vasospasm demonstrated by magnetic resonance angiography: case report. Neurosurgery. 1998;43:153–6. doi:10.1097/00006123-199807000-00101.

    Article  CAS  PubMed  Google Scholar 

  74. Robertson CS, Valadka AB, Hannay HJ, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med. 1999;27:2086–95. doi:10.1097/00003246-199910000-00002.

    Article  CAS  PubMed  Google Scholar 

  75. Dorhout Mees SM, Rinkel GJ, Feigin VL, et al. Calcium antagonists for aneurysmal subarachnoid hemorrhage. Stroke. 2008;39(2):514–5.

    Article  Google Scholar 

  76. Bailey I, Bell A, Gray J, et al. A trial of the effect of nimodipine on outcome after head injury. Acta Neurochir (Wien). 1991;110:97–105. doi:10.1007/BF01400674.

    Article  CAS  Google Scholar 

  77. Teasdale G, Bailey I, Bell A, et al. The effect of nimodipine on outcome after head injury: a prospective randomised control trial. The British/Finnish Co-operative Head Injury Trial Group. Acta Neurochir Suppl (Wien). 1990;51:315–6.

    CAS  Google Scholar 

  78. Harders A, Kakarieka A, Braakman R. Traumatic subarachnoid hemorrhage and its treatment with nimodipine. German tSAH Study Group. J Neurosurg. 1996;85:82–9.

    CAS  PubMed  Google Scholar 

  79. Xiao X, Guo X, Wang D, Xue G. Mechanism and treatment principle for cerebral vessel spasm caused by concussion. Chin J Traumatol. 2002;5:380–4.

    PubMed  Google Scholar 

  80. Kostron H, Rumpl E, Stampfl G, Russegger L, Grunert V. Treatment of cerebral vasospasm following severe head injury with the calcium influx blocker nimodipine. Neurochirurgia (Stuttg). 1985;28(Suppl 1):103–9.

    Google Scholar 

  81. Kostron H, Twerdy K, Stampfl G, Mohsenipour I, Fischer J, Grunert V. Treatment of the traumatic cerebral vasospasm with the calcium channel blocker nimodipine: a preliminary report. Neurol Res. 1984;6:29–32.

    CAS  PubMed  Google Scholar 

  82. Radhakrishnan D, Menon DK. Haemodynamic effects of intravenous nimodipine following aneurysmal subarachnoid haemorrhage: implications for monitoring. Anaesthesia. 1997;52:489–91. doi:10.1111/j.1365-2044.1997.112-az0105.x.

    Article  CAS  PubMed  Google Scholar 

  83. Wadworth AN, McTavish D. Nimodipine. A review of its pharmacological properties, and therapeutic efficacy in cerebral disorders. Drugs Aging. 1992;2:262–86. doi:10.2165/00002512-199202040-00002.

  84. Devlin JW, Coplin WM, Murry KR, Rengachary SS, Wilson RF. Nimodipine-induced acute hypoxemia: case report. Neurosurgery. 2000;47:1243–6; discussion 6–7. doi:10.1097/00006123-200011000-00048.

    Google Scholar 

  85. Armin SS, Colohan AR, Zhang JH. Traumatic subarachnoid hemorrhage: our current understanding and its evolution over the past half century. Neurol Res. 2006;28:445–52. doi:10.1179/016164106X115053.

    Article  PubMed  Google Scholar 

  86. Zwienenberg-Lee M, Hartman J, Rudisill N, Muizelaar JP. Endovascular management of cerebral vasospasm. Neurosurgery. 2006;59:S139–47; discussion S3–13. doi:10.1227/01.NEU.0000239252.07760.59.

    Google Scholar 

  87. Muizelaar JP, Zwienenberg M, Rudisill NA, Hecht ST. The prophylactic use of transluminal balloon angioplasty in patients with Fisher Grade 3 subarachnoid hemorrhage: a pilot study. J Neurosurg. 1999;91:51–8.

    CAS  PubMed  Google Scholar 

  88. Cairns CJ, Finfer SR, Harrington TJ, Cook R. Papaverine angioplasty to treat cerebral vasospasm following traumatic subarachnoid haemorrhage. Anaesth Intensive Care. 2003;31:87–91.

    CAS  PubMed  Google Scholar 

  89. Newell DW, Eskridge J, Mayberg M, Grady MS, Lewis D, Winn HR. Endovascular treatment of intracranial aneurysms and cerebral vasospasm. Clin Neurosurg. 1992;39:348–60.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of California, Davis Medical Center, School of Medicine, 4860 Y Street, Suite 3740, Sacramento, CA, 95817, USA

    Kiarash Shahlaie, James E. Boggan & J. Paul Muizelaar

  2. Department of Radiology, University of California, Davis Medical Center, Sacramento, CA, 95817, USA

    Richard E. Latchaw & Cheng Ji

Authors
  1. Kiarash Shahlaie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James E. Boggan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard E. Latchaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheng Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Paul Muizelaar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kiarash Shahlaie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shahlaie, K., Boggan, J.E., Latchaw, R.E. et al. Posttraumatic Vasospasm Detected by Continuous Brain Tissue Oxygen Monitoring: Treatment with Intraarterial Verapamil and Balloon Angioplasty. Neurocrit Care 10, 61–69 (2009). https://doi.org/10.1007/s12028-008-9138-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-008-9138-z

Keywords

Search

Navigation