Middle Cerebral Artery Embolectomy and Prolonged Widespread Vasospasm

Cerebral vasospasm following subarachnoid hemorrhage due to ruptured aneurysms has been discussed extensively during the past decade. Spasm involving the cerebral arteries also has been described in severe head injuries, infections, hypertensive encephalopathy and migraine. However, it has not been reported in cerebral embolism or following reconstructive cerebrovascular operations. Widespread and prolonged cerebral vasospasm was recently observed angiographically in a 40-year-old patient two weeks after a middle cerebral artery embolectomy. Although the repaired artery was patent, the patient's neurological recovery was slow and incomplete. With the increasing interest in cerebral microvascular procedures, more examples of vasospasm may be seen in the future. Its frequency and possible ill effects on neurological recovery and patency of the repaired artery, nevertheless, cannot be evaluated with certainty unless early postoperative angiograms are carried out.