Endovascular treatment for symptomatic vasospasm following traumatic brain injury: illustrative case.

backgroundThe optimal treatment for cerebral vasospasm (CV) following traumatic brain injury (TBI) has not been established, and management generally follows strategies developed for aneurysmal subarachnoid hemorrhage. OBSERVATIONS: The authors report a case of a patient with traumatic subarachnoid hemorrhage and cerebral contusion who presented with worsening consciousness and disorientation and subsequently developed symptomatic CV on day 6 of hospitalization. MRI and 3D CT demonstrated narrowing of the left internal carotid artery and middle cerebral artery (MCA) with reduced cerebral perfusion. Intra-arterial administration of fasudil hydrochloride yielded a temporary improvement. However, MCA stenosis recurred the next day, requiring percutaneous transluminal balloon angioplasty. Subsequent imaging showed improved cerebral perfusion, and the patient was discharged without delayed cerebral ischemia. LESSONS: Fluctuations in consciousness or neuropsychological symptoms after TBI should prompt evaluation for CV using perfusion imaging, even in the absence of focal neurological deficits. When a high risk of severe vasospasm accompanied by perfusion reduction is identified, prompt, stepwise therapeutic intervention should be implemented, beginning with the least invasive treatment option to optimize clinical outcomes. https://thejns.org/doi/abs/10.3171/CASE25943.