# Cerebral Infarction Due to Post-traumatic Cerebral Vasospasm in a 12-Year-Old Female

## TL;DR

A 12-year-old girl developed a brain infarction after a car accident due to rare post-traumatic cerebral vasospasm, highlighting the need for early detection in pediatric patients.

## Contribution

This case report emphasizes the diagnostic challenges and management of post-traumatic cerebral vasospasm in children.

## Key findings

- Post-traumatic cerebral vasospasm can lead to cerebral infarction in pediatric patients.
- Intracranial pressure monitoring is critical for detecting neurological events in sedated or comatose patients.
- Vascular evaluations like CTA and MRA are essential for early detection of vasospasm within two weeks of injury.

## Abstract

Cerebral infarction due to post-traumatic cerebral vasospasm is rare. Although some modalities are recommended to detect post-traumatic cerebral vasospasm, its diagnosis remains controversial and challenging. Therefore, in this report, we will use a case report to highlight challenges and to delineate the characteristics of post-traumatic cerebral vasospasm in pediatric patients, including the diagnostic and treatment options. A 12-year-old female was admitted to our hospital following a motor vehicle collision. Her consciousness was severely impaired. Initial computed tomography (CT) revealed an acute subdural hematoma along the tentorium, and a focal subarachnoid hemorrhage was observed in the Sylvian fissure. The patient underwent the insertion of an intracranial pressure sensor and received therapy for increased intracranial pressure (ICP) control under sedation. On the second day, CT angiography (CTA) revealed no signs of arterial abnormality. A patient who is comatose or under sedation has masked neurological symptoms. Thus, new neurological events could only be detected via an intracranial pressure sensor. Her ICP increased on the seventh day, and a CT scan showed a new cerebral infarction in the right middle cerebral artery (MCA) region. We performed decompressive craniectomy to reduce ICP. Postoperative CTA confirmed severe vasospasm in the right MCA. The severe cerebral vasospasm induced the cerebral infarction. Our review suggests that physicians in trauma departments should frequently perform vascular evaluations by CTA, magnetic resonance angiography (MRA), transcranial Doppler ultrasound, or digital subtraction angiography (DSA), especially within two weeks from onset, to detect post-traumatic cerebral vasospasm.