Prolonged delayed vasospasm in the setting of nonaneurysmal intraventricular hemorrhage

Background: Though still thought to be rare, in recent years, vasospasm as a result of primary intraventricular hemorrhage (IVH) has been increasingly recognized in patients with spontaneous primary intraventricular hemorrhage, of various etiologies. Unlike vasospasm in aneurysmal subarachnoid hemorrhage (SAH), which has a well-defined time frame of 3-21 days, such a window is poorly defined for primary spontaneous intraventricular hemorrhage from other vascular etiologies. Case Description: We report on two cases of prolonged delayed proximal intracranial cerebral vasospasm occurring 29 and 22 days after the initial presentation. Conclusion: To our knowledge, this is the first report of such delayed vasospasm in spontaneous primary intraventricular hemorrhage secondary to a dural arteriovenous fistula and cavernous malformation. Our two cases of vasospasm in patients with nontraumatic nonaneurysmal SAH with IVH presented outside the expected time period of 21 days. It is important to recognize that symptomatic vasospasm secondary to intraventricular hemorrhage is a rare but devastating complication that can have serious deleterious consequences if gone unrecognized and untreated.