Cerebral vasospasm associated with intraventricular hemorrhage.

BACKGROUND AND PURPOSE: Cerebral vasospasm remains a major complication associated with aneurysmal subarachnoid hemorrhage. Although several case reports have demonstrated that intraventricular hemorrhage (IVH) related to a ruptured arteriovenous malformation can result in vasospasm in the absence of subarachnoid hemorrhage, to our knowledge, this is the first case report of cerebral vasospasm associated with primary IVH.

CASE REPORT: A 44-year-old female was admitted with cerebellar infarction secondary to left posteroinferior cerebellar artery occlusion. Her hospital stay was complicated by primary IVH. Three days after her IVH, she became disoriented and developed a peculiar interest in counting numbers. This behavioral change was associated with an increase in cerebral blood flow velocity in the anterior circulation. Middle cerebral artery M1 velocity almost doubled from 65 to 130 cm/second. Her symptoms resolved with initiation of hypervolemia, hypertension, and hemodilution (triple H) therapy.

CONCLUSIONS

Cerebral vasospasm may contribute to the comorbidities of IVH. Routine transcranial Doppler may be warranted for screening of cerebral vasospasm in IVH patients.