Delayed symptomatic vasospasm after clipping of an unruptured intracranial aneurysm: case report and literature review

Symptomatic vasospasm after clipping of unruptured intracranial aneurysms is a rare phenomenon. Herein, a case of delayed symptomatic vasospasm that developed after clipping of a middle cerebral artery aneurysm is reported. The experience in treatment is introduced, and relevant literature is reviewed to investigate the potential pathogenesis. A 50-year-old male was diagnosed with an unruptured aneurysm of the right middle cerebral artery and treated with uneventful clipping under general anesthesia. Motor aphasia and subsequent hemiparesis occurred on the 10th postoperative day. Emergent head computed tomography angiography indicated severe vasospasm of right MCA. The patient was treated with volume expansion, oral nimodipine, and antiplatelet therapy. Recovery at 4 months follow-up as assessed by Glasgow Outcome Scale was IV. The sequelae included moderate weakness in the left hand and mild weakness in the leg. Delayed symptomatic cerebral vasospasm may occur after uneventful clipping of unruptured intracranial aneurysms, causing severe outcomes. Treatments such as volume expansion, vasodilators administration, and intra-arterial angioplasty should be administered to ensure favorable outcomes.