Stroke Associated with Severe Cerebral Vasospasm after Petroclival Meningioma Resection (P05.263)

Objective: We report a rare case of stroke associated with delayed severe vasospasm after resection of petroclival meningioma. Background Diffuse cerebral vasospasm is a frequent complication following aneurysmal subarachnoid hemorrhage or after severe traumatic brain injury; however, symptomatic cerebral vasospasm following intracranial tumor resection is a rare, and underrecognized condition. Design/Methods: A 55-year-old woman with a petroclival meningioma, presented with intractable seizures and decreased right hand dexterity, and underwent resection of the mass She underwent a nine hour and was discharged home on POD#7 with mild slurred speech and IV nerve palsy. Patient was readmitted on POD#11 for evaluation of four days of progressively worsening slurred speech and lethargy. Results: MRI showed patchy acute infarcts in the left posterior frontal, parietal and occipital lobes, perisylvian region, corpus callosum splenium, mesial temporal lobe, hypothalamus, and bilateral pontomesencephalic junctions. MRA was significant for diffuse vasospasm, including:1) severe stenosis of terminal ICAs bilaterally,2) significant stenosis in the proximal ACA A1, MCA M1, and ACA A2 segments bilaterally 3) moderate-severe stenosis in both vertebral arteries and severe stenosis in mid basilar artery and proximal PCA.Four-vessel angiogram confirmed the findings. Patient was subsequently treated with balloon angioplasty and intrarterial nicardipine, with marked improvement in symptoms. Conclusions: In conclusion, although vasospasm is rare following tumor resection, its existence has been well documented in an increasing number of cases. There is no clear inciting factor for this phenomenon; it is evident factors are likely implicated in the development of the vasospasm including blood in basal cisterns, vessel manipulation, and tumor-related inflammatory mediators. It appears that the interval for the occurrence of vasospasm after tumor resection follows that seen after aneurysmal SAH. One needs to have a high index of suspicion for vasospasm as a cause of neurological deterioration postoperatively after brain tumor resection so that prompt diagnosis and aggressive management is instituted. Disclosure: Dr. Chmayssani has nothing to disclose. Dr. Murthy has nothing to disclose. Dr. Ghosh has nothing to disclose. Dr. Bershad has nothing to disclose. Dr. Suarez has received personal compensation for activities with Bristol-Myers Squibb/Sanofi and Boehringer Ingelheim as a speaker. Dr. Suarez has received research support from the Haas Trust and NINDS.