Delayed Arterial Spasm and Thrombosis as a Cause of Post-Traumatic Hemiplegia (Spate Thrombosis)

The case of a Marine in whom a vertex epidural hematoma developed, depressing the superior sagittal sinus as a result of a fracture of the vertex of the skull, is presented. The hematoma was removed, and the patient did well until signs of progressive right hemiparesis suddenly developed two days after the hematoma removal. Serial carotid angiography demonstrated the interval development of spaism of the left internal carotid, anterior cerebral and middle cerebral arteries, and occlusion of the posterior parietal branch of the left middle cerebral artery. Prior to the development of the arterial spasm an earlier angiogram had shown these vessels to be of normal diameter. This delayed or “spate” spasm and thrombosis of major intracranial vessels is a rare but serious complication of head injuries. In addition to the usual causes of post-traumatic hemiplegias, this vascular spasm or thrombosis should be suspected in patients in whom progressive neurological signs develop after head injuries.