Intracranial arterial narrowing and spasm in acute head injury

Abstract

✓ Arteriography in 350 patients with a moderate to severe head injury, including repeated studies in 40 patients, revealed narrowing of one or more of the intracranial arteries in 65 patients (18.6%). Narrowing of the intracranial portion of the internal carotid artery and the first part of the anterior and middle cerebral arteries was found in 18 patients and was believed to be responsible for the clinical symptoms in some. Narrowing of the branches of the cerebral arteries at the site of the cerebral contusion was seen in 33 patients and diffuse narrowing of the intracranial arteries in 12. In two additional patients with gunshot wounds of the brain, there was narrowing of the cerebral artery adjoining a torn vessel. The evidence suggests that vascular spasm is responsible for the narrowing in some patients, while contusion and hemorrhage in the arterial wall is the cause in others. Whatever the mechanism, the occurrence and significance of cerebral arterial narrowing in association with acute head injury needs to be emphasized.

An overview of the basic science of concussion and subconcussion: where we are and where we are going

“…Angiographic vasospasm has been shown during the time period designated as Phase III in a separate work. 99 Maugans et al 53 studied pediatric patients ages 11 to 15 years old. They examined 12 athletes at 3 time points after injury (within 3 days, at 14 days, and 30 days or greater after concussion), comparing blood flow using phase-contrast angiography.…”

Reversible cerebral segmental vasoconstriction.

“…16 Alternating segments of constriction and dilatation are sometimes seen in leptomeningitis and various cerebral vasculitides, 17 including the acquired immunodeficiency syndrome 18 and following herpes zoster ophthalmicus. 19 It has not been a feature in cases of pathologically proven primary granulomatous angiitis of the central nervous system 20 -32 because this latter process appears restricted to vessels of ^0.5 mm diameter that are not visualized with angiography.…”

Posttraumatic cerebral infarction diagnosed by CT: prevalence, origin, and outcome.

“…Spasm is most prominent in the intradural portion of the distal internal carotid artery [6,9]. Spasm may be due to direct vascular trauma or adjacent contusion and hemorrhage, or may be mediated by release of a vasoactive humoral factor [8].…”