Cerebral vasospam is a well-known complication in aneurysmal subarachnoid hemorrhage (aSAH) that can lead to hypoperfusion and eventually delayed ischemia, which is a leading cause of morbidity and mortality in aSAH. Vasospasm in aSAH is expected to develop between days 4 and 14. For unclear reasons, vasospasm is less common after traumatic subarachnoid hemorrhage (tSAH) and if present, typically see in patients with severe head injuries. The onset has been reported to be as early as 1-2 days after injury and peaks at 5-7 days. We report a rare case of delayed cerebral ischemia occurring 14 days after mild traumatic head injury (GCS 14).

A 56-year-old man with no significant past medical history except for a motorcycle accident with head trauma found to have bilateral frontal lobe subarachnoid hemorrhage two weeks prior presented with sudden onset aphasia. CT angiogram demonstrated severe vasospasm of left M1/M2 portion of the middle cerebral artery (MCA) as well as portions of the anterior cerebral artery (ACA). Patient was started on oral nimodipine for vasospasm and aspirin. Magnetic resonance imaging demonstrated ischemic small infarcts in the distant left frontal and parietal lobes. Vasospasm was closely monitored with daily transcranial dopplers studies which showed improvement over the week. Clinically, his symptoms resolved, and he was discharged without any deficits.