• Fawaz Al-Mufti, Krishna Amuluru, Megan Lander, Melvin Mathew, Mohammad El-Ghanem, Rolla Nuoman, Seami Park, Vikas Patel, Inder Paul Singh, Gaurav Gupta, and Chirag D Gandhi.
• Department of Neurology, Neurosurgery, and Radiology, New York Medical College, Valhalla, New York, USA. Electronic address: fawazalmufti@outlook.com.
• World Neurosurg. 2018 Dec 1; 120: e68-e71.

BackgroundThe exact mechanism, incidence, and risk factors for cerebral vasospasm after traumatic intracranial hemorrhage (ICH) continue to be poorly characterized. The incidence of post-traumatic vasospasm (PTV) varies depending on the detection modality.ObjectiveWe aimed to shed light on the predictors, associations, and true incidence of cerebral vasospasm after traumatic ICH using digital subtraction angiography (DSA) as the gold standard.MethodsWe examined a prospectively maintained database of traumatic brain injury (TBI) patients to identify patients with ICH secondary to TBI enrolled between 2002 and 2015 at our trauma center. Patients with TBI-associated ICH and evidence of elevated velocities on transcranial Doppler and computed tomography angiograms, confirmed with DSA were included. The diagnostic cerebral angiograms were evaluated by 2 blinded neurointerventionalists for cerebral vasospasm. Statistical analyses were conducted to determine predictors of PTV.ResultsTwenty patients with ICH secondary to TBI and evidence of vasospasm underwent DSAs. Seven patients (7/20; 35%) with traumatic ICH developed cerebral vasospasm and of those, 1 developed delayed cerebral ischemia (1/7; 14%). Of these 7 patients, 6 presented with subarachnoid hemorrhage (6/7; 85%). Vasospasm was substantially more common in patients with a Glasgow Coma Scale <9 (P = 0.017) than in all other groups.ConclusionsPTV as demonstrated by DCA may be more common than previously reported. Patients who exhibit PTV were more likely to have a Glasgow Coma Scale <9. This subgroup of patients may benefit from more systematic screening for the development of PTV, and earlier monitoring for signs of delayed cerebral ischemia.Copyright © 2018. Published by Elsevier Inc.

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