PCT in Vasospasm After SAH with medical therapy undergo cerebral angiography and transluminal angioplasty (1,10–12). Aggressive treatment of vasospasm is not without risk (1,8). Hemodynamic augmenta- tion has a complication rate of 10–20% and balloon angioplasty may be complicated by vessel rupture, branch occlusion, and hemorrhagic infarction (1,8–11). Therefore, accurate monitor- ing of treatment effects in patients with vasospasm after SAH is needed. We report the results of the use of PCT to evaluate the effect of transluminal percutaneous angioplasty and intra- arterial papaverine in a patient with SAH and vasospasm- induced ischemia. Case Report A 37-year-old woman was admitted with severe sudden headache, nausea, vomiting, and neck stiffness (Hunt & Hess grade II). Unenhanced CT showed SAH predominantly in the left Sylvian fissure and over the left lateral convexity (Fisher grade 3). DSA showed a left internal carotid artery tip aneurysm, 41 which was treated with endovascular coil placement (Guglielmi Detachable Coils, Boston Scientific, Cork, Ireland). After the procedure she had mild headache and no neurological deficits. On the fourth day after coil placement, however, she developed aphasia. TCD revealed severe vasospasm. Despite hemody- namic augmentation and nimodipine, she remained symp- tomatic and angioplasty was considered. PCT was performed 6 days after coil placement to determine if there was brain tis- sue at risk for cerebral infarction. Angioplasty was performed and PCT was repeated after angioplasty. CT scanners with quadruple detector array were used be- fore and after angioplasty. For PCT, we used a technique de- scribed previously (3,4,7). In summary, after unenhanced CT of the brain, PCT was performed twice at two different levels, at the roof of the third ventricle and at the roof of the lateral ventricles. For each examination 40 mL of a nonionic contrast agent (iodixanol, Visipaque 320 mg of iodine per mL, GE Health, Cork, Ireland) were injected with a power injector into Fig. 1. PCT was performed to determine if the patient was at risk for cerebral infarction and whether transluminal angioplasty should be performed or not (A–C) and was repeated after angioplasty to monitor treatment effects on cerebral perfusion (D–F). (A) Preangioplasty PCT CBV map demonstrates increased CBV values in the left hemisphere, consistent with ischemia-related activation of cerebral autoregu- lation (blue to red: CBV = 0 to 20 mL/100g). (B) Preangioplasty PCT MTT map demonstrates increased MTT values in the left hemisphere, consistent with ischemia-related activation of cerebral autoregulation (red to blue: MTT = 0 to 15 seconds). (C) Preangioplasty PCT CBF map demonstrates normal to decreased CBF values in the left hemisphere (blue to red: CBF = 0 to 100 mL per 100 g and per minute). (D) Postangioplasty PCT CBV map demonstrates normalized CBV values in the left hemisphere, symmetric to the normal right side. (E) Post- angioplasty perfusion CT MTT map demonstrates normalized MTT values in the left hemisphere, symmetric to the normal right side. (F) Postangioplasty PCT CBF map demonstrates normalized CBF values in the left hemisphere, symmetric to the normal right side. Neurocritical Care ♦ Volume 6, 2007