PMC5214564_01
Magnetic resonance imaging (MRI) and computed tomography (CT) perfusion images of patient after her clinical decompensation on hospital day 17 and 22, respectively. There is an apparent diffusion coefficient (ADC) correlate to the diffusion-weighted imaging (DWI) signal (ADC map not shown). Low axial images on the left. High axial images on the right.
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F1
MRI was performed which showed interval development of restricted diffusion in the occipital lobes (Figure 1). Magnetic resonance angiography (MRA) showed bilateral anterior and middle cerebral artery and left vertebral artery stenosis.
Conventional cerebral angiography on hospital day 18. A follow-up angiogram on hospital day 24 was largely unchanged.
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F2
On HD #18, an angiogram was performed which showed vasospasm in all intracranial distributions (Figure 2).
Time course of arterial blood pressure and regional cerebral oxygenation (rSO2). The gap in blood pressure data represents the time at the first cerebral angiogram. The red bars, A and B, indicate the time range from which the data for Figure 4A and B were obtained. The upper and lower bounds of gray area represent systolic and diastolic blood pressure. The black line represents MAP.
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The lowering of blood pressure was associated with an increase in regional cerebral oxygenation (rSO2) over the frontal oximeter from 40% to 55% (Figure 3) as well as an improvement in examination.