Posttraumatic vasospasm detected by continuous brain tissue oxygen monitoring: Treatment with intraarterial verapamil and balloon angioplasty

Introduction: Posttraumatic vasospasm (PTV) is a relatively common event following traumatic brain injury (TBI) that has been strongly correlated with worse neurological outcome in many studies. However, vasospasm continues to be an under-recognized source of secondary injury following TBI, and currently published guidelines do not address screening or management strategies for PTV. Brain tissue oxygen (P_btO₂) monitoring probes allow for continuous screening for cerebral hypoxia following TBI, but their use as a monitor for PTV has not been previously described. Methods: Case report and literature review. Results: We present a case of PTV identified by persistent low P_btO₂ despite aggressive medical therapy. Computed tomography and digital subtraction angiography confirmed severe cerebral arterial vasospasm involving both anterior and posterior circulations. The patient was successfully treated with serial intraarterial therapy including balloon angioplasty and verapamil infusion. Conclusion: Posttraumatic vasospasm should be included in the differential diagnosis of cerebral hypoxia (e.g., low P_btO₂) following TBI. Management strategies for PTV may include early, aggressive intraarterial therapies including drug infusion and balloon angioplasty.