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Case Study
LB is a 44 year-old female who presented with a subarachnoid hemorrhage and an anterior communicating artery aneurysm which was clipped one day after the initial hemorrhage.

On post-bleed day #5 the patient's nurse noticed increasing lethargy. A transcranial Doppler study was ordered with the following results:

Right MCA: Proximal mean velocity = 233 cm/sec
                  Distal mean velocity = 147 cm/sec

Right MCA/ICA ratio = 6.6

Impression: Severe right MCA/ICA territory vasospasm.

SPECT showed moderately diminished perfusion in the right MCA territory consistent with vasospasm-induced ischemia.

Angiography confirmed the presence of severe right MCA vasospasm

Angiogram shows severe right MCA vasospasm

Angioplasty of the proximal right M1 segment of the MCA was done with residual severe vasospasm in the distal M2 segment.

Transcranial imaging was done on post-bleed day #6 showing normal flow velocities in the proximal right MCA (58 cm/sec) and severe vasospasm in the distal M2 segment (200 cm/sec).

Doppler spectra in the right MCA following angioplasty of the M1 segment of the MCA. The proximal MCA trunk velocity is normal.	The distal M2 segment velocity is significantly elevated consistent with severe vasospasm.

Her distal right MCA flow velocities returned to normal values on post-bleed day #10.

Right MCA flow velocities graphically illustrated showing the progression of vasospasm, the point at which angioplasty was performed and in the days following angioplasty.	Note that although the proximal MCA velolcity immediately decreases after angioplasty, the distal MCA velocities take longer to normalize.