Isolated Subcallosal Artery Infarction Secondary to Localized Cerebral Vasospasm of Anterior Communicating Artery Complex Following Subarachnoid Hemorrhage.

Abstract

Subcallosal artery (ScA) infarction is a well-recognized but uncommon complication of surgical treatment of anterior communicating artery aneurysms. An elderly man presented with massive subarachnoid hemorrhage due to left posterior communicating artery aneurysm with thick clots in the anterior interhemispheric fissure. The aneurysm was coiled with balloon protection, and later, on the fifth day of ictus, the patient became acutely confused and developed memory disturbances. Magnetic resonance evaluation revealed typical infarcts in the anterior subcallosal region and fornix, confirming ScA infarction. Retrospective analysis of follow-up angiograms revealed focal isolated spasm of the anterior communicating artery artery and ScA, responding to intra-arterial milrinone infusion that was administered in view of neurologic worsening and clinical suspicion of cerebral vasospasm. Our case demonstrates a rare case of isolated ScA infarction induced by a local vasospasm and highlights the importance of its recognition. An early identification and intervention could potentially halt irreparable cerebral injury.