1248. Ultra-Early Vasospasm and Retreatment: Two Phenomenon Following Aneurysmal Subarachnoid Hemorrhage: Literature Review and Case Study

Authors: Steven Tenny, MD; Clayton Korson, BS; Steven Tenny; William Thorell, MD (Omaha, NE)

Introduction: Subarachnoid hemorrhage accounts for ~5% of all strokes and can be complicated by vasospasm. Vasospasm may occur in two time periods, ultra-early within the first 24-48 hours and typical within post-bleed days approximately 3-14. Methods: We report a case of a patient exhibiting both ultra-early and more typical symptomatic vasospasm after aneurysmal subarachnoid hemorrhage who needed treatment and re-treatment with endovascular methods. We summarize recent literature on the possible etiologies and treatment of symptomatic aneurysmal subarachnoid hemorrhage vasospasm. Results: Typical vasospasm occurs around post-bleed days 3-14 after aneurysmal subarachnoid hemorrhage but a variant, ultra-early vasospasm, has been reported. Ultra-early vasospasm typically presents within the first 24-48 hours following subarachnoid hemorrhage. Although the specific pathophysiology of ultra-early and typical vasospasm are active areas of investigation, their specific pathways remain elusive. Despite this, treatment options are available. Conclusion: Our patient demonstrated both ultra-early and typical vasospasm requiring treatment with endovascular techniques to decrease the risk of morbidity. Vasospasm remains a significant contributor to morbidity for subarachnoid hemorrhage patients and warrants our continued efforts to understand, prevent and treat.