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Case Reports
. 2021 Feb 22;1(8):CASE2053.
doi: 10.3171/CASE2053.

Posterior communicating artery injury and symptomatic vasospasm after high-energy blunt head injury: illustrative case

Nidal B Omar  1 , Gustavo Chagoya  1 , Dario Marotta  2 , Galal Elsayed  1 , Mark R Harrigan  1
Affiliations
Case Reports

Posterior communicating artery injury and symptomatic vasospasm after high-energy blunt head injury: illustrative case

Nidal B Omar et al. J Neurosurg Case Lessons. .

Abstract

Background: Most of the published literature pertaining to blunt traumatic cerebrovascular injury (BCVI) is focused on extracranial arterial injury. Studies of intracranial arterial injury are relatively uncommon.

Observations: The clinical course of a patient who sustained an injury to the right posterior communicating artery followed by infarction due to vasospasm after severe traumatic brain injury is presented, along with a focused literature review.

Lessons: Intracranial BCVI is uncommon, and this report may serve to raise awareness of BCVI management and the importance of recognizing symptomatic vasospasm due to BCVI.

Keywords: BCVI = blunt traumatic cerebrovascular injury; CT = computed tomography; CTA = computed tomography angiogram; DSA = digital subtraction angiography; ICA = internal carotid artery; ICP = intracranial pressure; MCA = middle cerebral artery; NICU = neurological intensive care unit; PComm = posterior communicating artery; SAH = subarachnoid hemorrhage; aSAH = aneurysmal subarachnoid hemorrhage; blunt traumatic cerebrovascular injury; cerebral artery avulsion; severe traumatic brain injury; symptomatic vasospasm; tSAH = traumatic subarachnoid hemorrhage; traumatic subarachnoid hemorrhage.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
Admission noncontrasted CT scans demonstrating diffuse SAH in the basal cisterns and pneumocephalus.
FIG. 2.
FIG. 2.
Admission CTAs demonstrating abnormal pooling of contrast adjacent to the right supraclinoid ICA.
FIG. 3.
FIG. 3.
Initial diagnostic angiograms: lateral right ICA injection (left) and magnified view of the injured right PComm origin (right). “Right” refers to a right-sided DSA injection.
FIG. 4.
FIG. 4.
Precoiling lateral ICA injection with microcatheter in place (left) and postcoiling result (right). “Right” refers to a right-sided DSA injection.
FIG. 5.
FIG. 5.
DSA demonstrating focal spasm of the right M1 segment.
See this image and copyright information in PMC

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