Aneurysmal subarachnoid hemorrhage and severe, catheter-induced vasospasm associated with excessive consumption of a caffeinated energy drink

Abstract

Excessive consumption of over-the-counter stimulants is associated with coronary vasospasm, thrombotic complications, and sudden cardiac death. Their effects on cerebrovascular physiology are not yet described in the neurointerventional literature. Patients are increasingly exposed to high levels of these vasoactive substances in the form of caffeinated energy drinks and specialty coffees. We report a case of aneurysmal subarachnoid hemorrhage (SAH) and severe, catheter-induced vasospasm during attempted endovascular repair of a ruptured anterior communicating artery (AComA) aneurysm in the setting of excessive energy drink consumption. We review the literature and alert clinicians to this potentially serious complication.

Keywords: Caffeine; catheter-induced vasospasm; energy drink; subarachnoid hemorrhage; thrombosis.

Figure 1.

(a) Axial noncontrast CT demonstrating diffuse SAH. (b) The accompanying CT angiogram demonstrates a small AComA aneurysm. T1-weighted black blood vessel wall sequences (coronal plane) before (c) and after (d) administration of gadolinium demonstrate thick contrast enhancement of the AComA aneurysm wall, consistent with its being the site of rupture. The arrow points to the AComA aneurysm. AComA: anterior communicating artery; SAH: subarachnoid hemorrhage. CT: computed tomography; SAH: subarachnoid hemorrhage; AComA: anterior communicating artery.

Figure 2.

(a) Digital subtraction angiogram (AP view) demonstrates catheter-induced vasospasm in the high cervical/petrous segments of the ICA (arrow) around a delivery catheter with a balloon catheter positioned in the right A1 segment over a guidewire. Note the early formation of a filling defect in the supraclinoid ICA (double arrows). (b) A later frame in the same angiographic run demonstrates the near occlusive nature of the vasospasm with significant stasis of contrast. (c) Digital subtraction angiogram (AP view) demonstrates migration of a clot from the supraclinoid ICA into the right M1 segment (arrow). (d) Axial diffusion-weighted imaging with apparent diffusion coefficient mapping (e) demonstrates a post-procedural right MCA infarct. (f) Digital subtraction angiogram (AP view) demonstrates recurrent, catheter-induced vasospasm in the cervical ICA during a second endovascular procedure (arrow). This was successfully managed with early recognition, intra-arterial verapamil administration, and repositioning of the delivery catheter. AP: anteroposterior; ICA: internal carotid artery; MCA: middle cerebral artery.