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Cerebral vasospasm: case report A 51-year-old woman developed cerebral vasospasm following treatment with carmustine polifeprosan 20 wafer for glioblastoma [route and dosage not stated]. The woman was transferred following detection of an insular lesion. She had initially presented with smelling odd odours and headaches and treated with levetiracetam. An MRI showed moderate perilesional oedema. She then underwent frototemporal craniotomy for tumour resection. Following examinations, high-grade glioma was confirmed. Hence, the decision was made to line the surgical cavity, including large cerebral vessels and Sylvian fissure, with four carmustine polifeprosan 20 wafers [Gliadel; carmustine wafer]. Two wafers were placed along the cephalad resection cavity in direct contact with the exposed portion of the Sylvian fissure and the remainder along the posterior resection wall. Post-operatively, she did not develop any worsening deficits, however, a post-operative CT scan showed haemorrhage. On day 1, MRI showed subtotal resection with improved mass effect. On day 5, she was discharged from the hospital. On day 8, she developed left lower extremity weakness, which progressed to left facial weakness and slurred speech. Over the next 24 hours, she developed severe hemiparesis and plegia in the left lower extremity. On day 9, digital subtraction angiography and CT angiography showed moderate vasospasm in the carotid terminus, right supraclinoid internal carotid artery, M1 of the middle carotid artery and A1 of the anterior cerebral artery, consistent with cerebral vasospasm secondary to the carmustine polifeprosan 20 wafer. The woman was treated with nicardipine. Subsequently, she underwent angioplasty of the supraclinoid internal carotid artery and middle carotid artery with improvement in vessel caliber and diameter. She remained in the hospital for several days for the management of vasospasm (received unspecified fluids and nimodipine), and rehabilitation. Histopathology features consistent with grade IV glioblastoma. She received radiation and temozolomide. At 36 month follow-up, she had resolution of dysphagia. However, she had persistent left lower extremity paresis and left upper extremity plegia. Khan MQ, et al. Symptomatic cerebral vasospasm in the setting of carmustine wafer placement for glioblastoma: A case presentation and review of literature. Surgical 803517215 Neurology International 11: 27 Jun 2020. Available from: URL: http://doi.org/10.25259/SNI_257_2020

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Reactions 28 Nov 2020 No. 1832